What is the management approach for fissure nodules in the lungs?

From the Guidelines

The management of fissure nodules in the lungs typically involves surveillance with serial imaging rather than immediate intervention, with a follow-up CT scan in 6-12 months generally recommended to monitor for any changes in size or characteristics, as suggested by the most recent guidelines 1. The approach to managing fissure nodules is largely based on their characteristics and the patient's risk factors for lung cancer. Most fissure nodules are benign, representing intrapulmonary lymph nodes, pleural tags, or focal areas of fibrosis, particularly when they are small (less than 1 cm), have smooth margins, and are located within the fissures.

• Key factors influencing the management approach include:
  • Nodule size and characteristics
  • Patient's risk factors for lung cancer, such as smoking history, family history, or prior malignancy
  • Presence of concerning features like irregular borders, spiculation, or growth over time
• For nodules with concerning features or in patients with high risk factors, more aggressive evaluation may be warranted, including:
  • Shorter interval follow-up imaging (3-6 months)
  • PET-CT scanning
  • Tissue sampling via bronchoscopy, CT-guided biopsy, or surgical resection
• The conservative approach to most fissure nodules is justified by their predominantly benign nature and the fact that their location within the fissures makes them more likely to be benign lymph nodes rather than primary lung malignancies, as supported by recent recommendations 1.
• It is essential to consider the patient's preferences and discuss the risks and benefits of management strategies, as emphasized in the guidelines 1.
• The use of low-dose CT techniques and standardized acquisition and reconstruction protocols can help improve the accuracy of nodule characterization and follow-up, as highlighted in recent studies 1.

From the Research

Management Approach for Fissure Nodules in the Lungs

The management of fissure nodules in the lungs involves a careful approach to balance the risk of malignancy with the risk of unnecessary diagnostic procedures.

• The study by 2 found that perifissural nodules (PFNs) are frequently seen on screening CT scans obtained in high-risk subjects, but the malignancy potential of PFNs is low.
• The management of lung nodules detected during computed tomography lung cancer screening programs can be challenging, as noted by 3, who evaluated the pitfalls, difficulties, and sources of mistakes in the management of lung nodules detected in volunteers.
• The use of computational geometry methods, such as those described by 4, can aid in the automated segmentation of pulmonary fissures in CT examinations, which may be useful in the assessment of lung disease.
• It is essential to consider alternative diagnoses, such as nodular sarcoidosis, which can masquerade as cancer, as reported by 5.
• The study by 6 describes a new approach for segmenting the major fissures in both lungs on thin-section computed tomography (CT), which may be useful in the assessment of lung disease on a lobar level.

Key Considerations

• Fissure nodules are common in high-risk subjects, but their malignancy potential is low 2.
• The management of lung nodules requires a multidisciplinary approach to minimize misdiagnoses 3.
• Computational geometry methods can aid in the automated segmentation of pulmonary fissures in CT examinations 4.
• Alternative diagnoses, such as nodular sarcoidosis, should be considered in the evaluation of lung nodules 5.