Lung nodules: size still matters

摘要

The incidence of indeterminate pulmonary nodules has risen constantly over the past few years. Determination of lung nodule malignancy is pivotal; because the early diagnosis of lung cancer could lead to a definitive intervention. According to the current international guidelines; size and growth rate represent the main indicators to determine the nature of a pulmonary nodule. However; there are some limitations in evaluating and characterising nodules when only their dimensions are taken into account. There is no single method for measuring nodules; and intrinsic errors; which can determine variations in nodule measurement and in growth assessment; do exist when performing measurements either manually or with automated or semi-automated methods. When considering subsolid nodules the presence and size of a solid component is the major determinant of malignancy and nodule management; as reported in the latest guidelines. Nevertheless; other nodule morphological characteristics have been associated with an increased risk of malignancy. In addition; the clinical context should not be overlooked in determining the probability of malignancy. Predictive models have been proposed as a potential means to overcome the limitations of a sized-based assessment of the malignancy risk for indeterminate pulmonary nodules.