ACR Appropriateness Criteria® Indolent Lung Cancer

Area of Science:

• Pulmonology
• Radiology
• Oncology

Background:

• Persistent or slow-growing subsolid nodules and atypical lung cysts may indicate indolent lung cancer.
• Management requires multidisciplinary tumor board assessment for risk, natural history, and treatment.
• Imaging surveillance is preferred when active intervention is delayed, aiming to detect significant changes.

Purpose of the Study:

• To outline evidence-based guidelines for imaging surveillance of indolent pulmonary nodules.
• To guide clinicians in selecting appropriate imaging modalities for detecting changes that influence treatment decisions.
• To provide a framework for managing patients with indolent lung nodules when intervention is deferred.

Main Methods:

• Systematic analysis of peer-reviewed medical literature.
• Adaptation of established methodology principles like Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
• Utilizing the RAND/UCLA Appropriateness Method for evaluating imaging and treatment procedures.
• Inclusion of expert opinion when literature is lacking or equivocal.

Main Results:

• Guidelines focus on imaging surveillance for indolent pulmonary nodules where intervention is delayed.
• Emphasis on selecting imaging modalities based on accuracy and impact on treatment decisions.
• Distinction between surveillance imaging and diagnostic workup/biopsy when treatment is indicated.

Conclusions:

• Imaging surveillance is crucial for indolent pulmonary nodules when intervention is delayed.
• Guidelines support informed decision-making regarding treatment based on detected changes.
• The American College of Radiology Appropriateness Criteria provide a framework for these evidence-based guidelines.