Pulmonary nodules / Consultation template
Pulmonary nodule surveillance plan
The record of what was found, what the risk score said, and exactly when the next scan is due and who is arranging it.
- 1Nodule found on
- 2Site
- 3Size
- 4mm maximum diameter, volume
- 5Margins
- 6Number
- 7Other findings
- 8Age
- 9smoking
- 10pack-years
- 11Asbestos or other occupational exposure
- 12Previous malignancy
- 13Family history of lung cancer
- 14Brock model risk of malignancy
- 15Herder model risk after PET-CT
- 162. Next scan due
and 3 more, in the block below.
Pulmonary nodule assessment. Nodule found on: [scan type and date, and why it was done] Comparison with previous imaging: [date of earliest available prior imaging, and whether the nodule was present] Nodule characteristics: Site: [lobe and segment] Size: [] mm maximum diameter, volume [] mm3 Character: [solid, part-solid with solid component of, or pure ground glass] Margins: [smooth, lobulated, spiculated] Number: [solitary, or number and distribution] Other findings: [emphysema, fibrosis, lymphadenopathy] Risk: Age [], smoking [current, ex with quit date, or never], pack-years [] Asbestos or other occupational exposure: [] Previous malignancy: [] Family history of lung cancer: [] Brock model risk of malignancy: []% Herder model risk after PET-CT: []% Assessment: [below the size threshold for follow-up, or under surveillance, or being worked up for possible malignancy] Plan: 1. [discharge with no further imaging, interval CT, PET-CT, biopsy, or referral for treatment] 2. Next scan due: [month and year], to be requested by [chest clinic, GP, or radiology recall] 3. Surveillance ends: [month and year] if stable 4. Patient informed of the plan and the reason for it: [yes] 5. Smoking cessation offered: [] If the nodule grows on any interval scan, the patient should be referred back to the chest clinic rather than continuing surveillance.
How to use it
The failure mode with nodules is not misjudging one scan; it is losing the person between scans. So the block records the month the next scan is due, who is responsible for requesting it, and the date surveillance ends — three facts that are usually implied and therefore lost when the letter is read by someone else two years later. Record the earliest prior imaging you could find: a nodule unchanged for two years is a different object from the same nodule seen once. Write the Brock score as a number rather than describing the risk as low, so the next reader can see what it was based on.
Why it says that
None of this is in the copied text. It is here so you can check the block against its source, and change it when the source changes.
- BTS guideline for the investigation and management of pulmonary nodules (2015) Size and volume thresholds for surveillance, volume doubling time on repeat CT, the Brock model before PET-CT and the Herder model after it, and the separate pathway for subsolid nodules.
- Fleischner Society 2017 guidelines for management of incidental pulmonary nodules The international counterpart, and the one many radiology reports quote. Where the two differ, say in the letter which you are following.
- NHS England lung cancer screening programme protocol Nodules found through screening follow the programme's own protocol rather than this pathway.
Trials behind it
- NELSON 2020 Volume CT screening reduced lung cancer mortality with a 2.1% referral rate
- NLST 2011 Low-dose CT screening reduced lung cancer mortality — at the cost of a 96% false-positive rate
Records on respiratorytrials.org.