The common clinical management of lung nodules includes follow-up with serial CT scans, biopsy, and surgery. The choice is based on the type of lung nodule, the risk of malignancy, risk factors, and potential surgical risks.

CT-scan follow-up

CT-scan follow-up is the most common method of managing lung nodules. The follow-up of chest CT can monitor the possible changes of lung nodules. It commonly works for nodules with a very low or low risk of malignancy. Follow-up may also be an option for people with contraindications to biopsy or surgical treatment.

Follow-up is performed with HRCT. The interval of follow-up may be longer or shorter, depending on the doctor’s assessment of the risk of the nodule.

Biopsy

A biopsy is sometimes necessary to make a definitive diagnosis of a lung nodule. As it is an invasive test, biopsy carries potential risks. It is appropriate for lung nodules with moderate malignant potential. It is also useful in cases requiring clear preoperative evidence of malignancy, especially when surgery poses significant risks for the patient.

In most cases, lung nodule biopsy involves obtaining a tissue specimen of the nodule by percutaneous puncture to clarify its nature. In rare cases, lung biopsy by fibreoptic bronchoscopy may also confirm the diagnosis.

Surgical procedures

Surgery is an important method for the definitive diagnosis and treatment of lung nodules. Surgical treatment is recommended for lung nodules with a high risk of malignancy unless the patient has contraindications or is unable to tolerate surgery.

Common surgical approaches include minimally invasive surgery (MIS) and open chest. Video-assisted thoracoscopic surgery (VATS) such as Thoracoscopic resection (including wedge resection, segmental lung resection, and lobectomy) is the most common method of diagnosing and treating highly malignant pulmonary nodules.

In addition to the above, other treatments such as radiotherapy and chemotherapy are sometimes used if the condition warrants.