ACR Appropriateness Criteria® Radiologic Management of Pulmonary Nodules and Masses: Update 2025

Area of Science:

• Pulmonary Medicine
• Thoracic Imaging
• Oncology

Background:

• Pulmonary nodules and masses are common findings in thoracic imaging.
• Lung cancer presents a significant mortality burden.
• Management strategies require careful consideration of clinical context.

Purpose of the Study:

• To provide evidence-based guidelines for the management of pulmonary nodules and masses.
• To systematically evaluate imaging and procedural options for various clinical scenarios.
• To offer recommendations for clinicians based on multidisciplinary expert consensus.

Main Methods:

• Systematic review of peer-reviewed literature.
• Supplementation with expert consensus where literature is lacking.
• Application of established methodologies like GRADE and the RAND/UCLA Appropriateness Method.

Main Results:

• Key recommendations focus on the role of tissue sampling for enlarging or suspicious nodules.
• Selective use of PET/CT for characterization and treatment planning is highlighted.
• Balancing diagnostic yield against procedure-related risks (e.g., pneumothorax, hemorrhage) is crucial.

Conclusions:

• Guidelines address stable nodules, enlarging nodules, location-specific findings, nodules in patients with prior malignancy, and persistent ground-glass opacities.
• Recommendations guide the appropriate use of imaging (CT, PET/CT) and interventions (biopsy, ablation, surgery).
• Multidisciplinary expert review ensures comprehensive and current management strategies for pulmonary nodules and masses.