Management of Subsolid Nodules: Response

Abstract

We thank Dr Kakinuma and colleagues for their interest in the third edition of the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines for the diagnosis and management of lung cancer.1Gould MK Donington J Lynch WR et al.Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.Chest. 2013; 143: e93S-e120SAbstract Full Text Full Text PDF PubMed Scopus (883) Google Scholar They correctly point out some differences between the ACCP guidelines and the recommendations of the Fleischner Society for the evaluation of patients with subsolid nodules.1Gould MK Donington J Lynch WR et al.Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.Chest. 2013; 143: e93S-e120SAbstract Full Text Full Text PDF PubMed Scopus (883) Google Scholar, 2Naidich DP Bankier AA MacMahon H et al.Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society.Radiology. 2013; 266: 304-317Crossref PubMed Scopus (776) Google Scholar The ACCP guidelines definition of nodule size refers to the widest nodule diameter, as is most commonly reported in clinical practice. For both nonsolid (pure ground glass) and part-solid nodules, the thresholds refer to the entire nodule because delineation of solid and nonsolid components may be especially challenging in usual practice settings, and documentation rarely is complete. Regarding window settings and other technical aspects of measurement by radiologists, we defer to the Fleischner Society recommendations. In hindsight, the language in our remark about proceeding directly to further evaluation in patients with part-solid nodules measuring > 15 mm in diameter may have been too strong. It is not unreasonable to repeat chest CT scanning in 3 months in such patients, although the evidence in support of this practice is only anecdotal. Management of Subsolid NodulesCHESTVol. 144Issue 5PreviewWe recently read with great interest the article by Gould et al1 in the American College of Chest Physicians lung cancer guidelines in CHEST (May 2013), and we certainly appreciate the authors' hard work and diligent efforts in presenting the guidelines. However, we were surprised to see several inconsistencies between the article and a statement from the Fleischner Society by Naidich et al,2 published in the January 2013 issue of Radiology, regarding subsolid nodules. Full-Text PDF