Evaluating pulmonary nodules to detect lung cancer: Does Fleischner criteria really work?

Abstract

Objective: The Fleischner Society recommends that interval computed tomography (CT) be conducted as a follow-up for managing incidental small pulmonary nodules detected in CT scans. This study evaluated the clinical application of Fleischner criteria using a large cohort of patients at high risk for lung cancer with low-dose CT screening. Materials and methods: During the years 2012–2016, a retrospective study of 176 patients was reviewed for incidental lung nodules. Patient eligibility included: men and women from 55 to 74 years of age; a 30 pack per year smoking history, and the patient quit smoking in the last 15 years; no cancer history within the last 5 years; and no previous CT chest scan performed. The Fleischner criteria was used to calculate proper patient follow-up and management. Nodules were classified based on several features, including but not limited to size and shape; characteristics of nodules were tabulated and analyzed using the Chi-squared and t-tests. Results: Out of 176 patients, 117 had nodules with a total of 210 total nodules detected. Table 1 shows the categorization of all nodule features including the Fleischner Criteria. Of the entire cohort, two patients (1.1%) had malignant disease: one was a part-solid nodule of 10.2 mm, and the other was a multiple subsolid ground glass nodule (GGN) of 20.1 mm. Twenty-one patients (17.9%) had undergone unnecessary follow-up CT scans, including those with solitary pure GGNs. Conclusion: This study emphasizes the need for new Fleischner guidelines to minimize over-diagnosis, unnecessary follow-ups, cost, and dosage of radiation. Such new guidelines will certainly estimate the risk of malignancy with greater accuracy.

Keywords

• Lung cancer
• Low-dose computed tomography scan
• Fleischner criteria
• Malignancy
• Radiology