From the Guidelines
You should refer a patient with a growing pulmonary nodule to a pulmonologist as the first step, as they have specialized training to evaluate lung nodules and determine the need for additional specialists, such as a thoracic surgeon or oncologist, based on the nodule's characteristics and the patient's medical history. The pulmonologist will likely order additional imaging, such as high-resolution CT scans or PET scans, and may recommend procedures like bronchoscopy or needle biopsy to determine the nature of the nodule 1. According to the American College of Radiology, guidelines for managing incidental pulmonary nodules recommend follow-up tests based on the estimated lung cancer risk, taking into account the patient's risk factors and preferences 1.
The management of pulmonary nodules requires a multidisciplinary approach, involving thoracic surgeons, thoracic radiologists, and pulmonologists to determine the likelihood of a cancer diagnosis and the optimal diagnostic or follow-up strategy 1. The Fleischner Society and American College of Chest Physicians guidelines provide recommendations for managing incidental pulmonary nodules based on the nodule's potential for clinically significant disease 1.
Key considerations in evaluating pulmonary nodules include:
- Nodule size and morphology
- Patient risk factors for malignancy
- Suitability for curative treatment
- The presence of associated abnormalities, such as lymphadenopathy or pleural effusion 1 The specialist will evaluate these factors to determine the best course of action, which may include surveillance, biopsy, or surgical excision, depending on the nodule's characteristics and the patient's overall health 1.
From the Research
Referral Options for Patients with Growing Pulmonary Nodules
- Patients with growing pulmonary nodules should be referred to a multidisciplinary team, including a pulmonologist, thoracic surgeon, and radiologist, for further evaluation and management 2, 3, 4.
- The referral should be based on the estimated probability of malignancy, patient comorbidities, and patient preferences 2, 5, 6.
- A thoracic surgeon may play a key role in leading the discussion and shaping the treatment strategies for patients with CT screen-detected lung nodules 3.
Specialized Care
- Patients with solid pulmonary nodules 8 mm or larger may require surveillance imaging, nonsurgical biopsy, or surgical resection, and should be referred to a specialist for further evaluation 5.
- Part-solid pulmonary nodules should be managed according to the size of the solid component, and patients with these nodules may benefit from referral to a thoracic surgeon or pulmonologist 5.
- Ground-glass pulmonary nodules with a high probability of malignancy may require closer monitoring or referral to a specialist for further evaluation 5.
Patient-Centered Care
- Patient-provider communication and decision-making should be tailored to the individual patient, taking into account their concerns, preferences, and values 6.
- A patient-centered approach to discussing and managing pulmonary nodules can improve patient satisfaction, reduce distress, and increase adherence to evaluation and treatment plans 6.