Lung nodules: size still matters

Eur Respir Rev. 2017 Dec 20;26(146):170025. doi: 10.1183/16000617.0025-2017. Print 2017 Dec 31.


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.

Publication types

  • Review

MeSH terms

  • Cell Proliferation
  • Disease Progression
  • Early Detection of Cancer / methods*
  • Humans
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / pathology
  • Lung Neoplasms / therapy
  • Multidetector Computed Tomography*
  • Multiple Pulmonary Nodules / diagnostic imaging*
  • Multiple Pulmonary Nodules / pathology
  • Multiple Pulmonary Nodules / therapy
  • Predictive Value of Tests
  • Prognosis
  • Risk Factors
  • Solitary Pulmonary Nodule / diagnostic imaging*
  • Solitary Pulmonary Nodule / pathology
  • Solitary Pulmonary Nodule / therapy
  • Tumor Burden