Editing Lung nodules (section)

== Initial workup ==

* Assess risk of malignancy as low (<5%), intermediate (5-65%), or high (>65%)
** This is most necessary for nodules 8-30mm in size, since management is generally identical for all nodules at either end of that range
** High-risk features: 
*** Smoking history (OR 7.9)
*** Older age
*** Female sex
*** Family history lung cancer
*** Emphysema
*** Larger nodule size
*** Location of nodule in upper lobe
*** Part-solid nodule type
*** Lower nodule count
*** Spiculation
*** Prior malignancy (met unless proven otherwise)
*** Asbestos exposure
* Assess with imaging


'''Factors that influence the management of nodules 8 to 30 mm in size'''
{| class="wikitable"
|'''Factor'''
|'''Level'''
|'''CT scan surveillance'''
|'''PET imaging'''
|'''Nonsurgical biopsy'''
|'''VATS wedge resection'''
|-
|'''Clinical probability of lung cancer'''
|Very low (<5%)
|<nowiki>++++</nowiki>
|–
|–
|–
|-
|
|Low-moderate
|<nowiki>+</nowiki>
|<nowiki>+++</nowiki>
|<nowiki>++</nowiki>
|<nowiki>+</nowiki>
|-
|
|High (<65%)
|–
|(± staging)
|<nowiki>++</nowiki>
|<nowiki>++++</nowiki>
|-
|'''Surgical risk'''
|Low
|<nowiki>++</nowiki>
|<nowiki>++</nowiki>
|<nowiki>++</nowiki>
|<nowiki>+++</nowiki>
|-
|
|High
|<nowiki>++</nowiki>
|<nowiki>+++</nowiki>
|<nowiki>++</nowiki>
|–
|-
|'''Biopsy risk'''
|Low
|–
|<nowiki>++</nowiki>
|<nowiki>+++</nowiki>
|<nowiki>+++</nowiki>
|-
|
|High
|<nowiki>++</nowiki>
|<nowiki>+++</nowiki>
|–
|<nowiki>+</nowiki>
|-
|'''High suspicion of active infection or inflammation'''
|
|–
|–
|<nowiki>++++</nowiki>
|<nowiki>++</nowiki>
|-
|'''Values and preferences'''
|Desires certainty
|–
|<nowiki>+</nowiki>
|<nowiki>+++</nowiki>
|<nowiki>++++</nowiki>
|-
|
|Risk averse to procedure-related complications
|<nowiki>++++</nowiki>
|<nowiki>+++</nowiki>
|<nowiki>++</nowiki>
|–
|-
|'''Poor adherence with follow-up'''
|
|–
|–
|<nowiki>+++</nowiki>
|<nowiki>++++</nowiki>
|}