Pulmonary Nodule Smart Manager · Follow-up & Surgical Decision — free guideline decision tool

This tool turns nodule type, size, scenario, risk, and dynamics into classification, malignancy stratification, follow-up, diagnostic approach, surgical window, and procedure recommendation in one pass.

Screening → Lung-RADS category by type/size/solid component. Incidental → Fleischner by type and size. Surgical window triggered by Lung-RADS 4B, solid > 8 mm, part-solid solid component ≥ 6 mm, or persistent enlarging GGN ≥ 10 mm.

Use to classify by Lung-RADS (screening) or Fleischner (incidental), refine follow-up with the Chinese 2024 consensus, and gauge the surgical window and procedure.

Sublobar resection requires preoperatively negative mediastinal staging, and intraoperative N1/N2 mandates conversion to lobectomy. (original synthesis · not guideline verbatim) Pure GGN is prone to PET false-negatives and a long doubling time does not exclude indolent adenocarcinoma. Solid-component size and growth are the core invasiveness markers driving escalation.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: Detection scenario Checkup/incidental (Fleischner), Nodule type Solid, Total nodule diameter (mean) 9 mm, Solid-component diameter (required for part-solid) 5 mm, Lung-cancer risk Low risk, Compared with prior CT Baseline/first detection, Number Single, Location (affects procedure) Peripheral (outer 1/3) → Result: Conclusion Fleischner solid > 8 mm · surgical-assessment window（Classification: Fleischner solid > 8 mm (malignancy probability ~3%+, assess by probability), (1) Follow-up strategy: Enter active assessment: choose one of CT at 3 months / PET-CT / tissue sampling., (2) Diagnostic approach: PET-CT (high value for solid ≥ 8 mm; often false-negative and of limited value for pure/subsolid ground-glass); non-surgical biopsy — peripheral nodules CT-guided transthoracic needle biopsy (TTNB), central/needing mediastinal staging use bronchoscopy + EBUS-TBNA; indeterminate nodules (highly suspected early cancer but biopsy inconclusive) → MDT + shared decision-making.） Inputs: Detection scenario LDCT lung-cancer screening (Lung-RADS), Nodule type Pure ground-glass pGGN, Total nodule diameter (mean) 9 mm, Solid-component diameter (required for part-solid) 5 mm, Lung-cancer risk High risk (≥ 40 yr and smoking ≥ 20 pack-years/family history/COPD/occupational exposure, etc.), Compared with prior CT New or enlarging, Number Multiple, Location (affects procedure) Central → Result: Conclusion Lung-RADS 2 · follow-up primary（Classification: Lung-RADS 2 (malignancy probability < 1%), (1) Follow-up strategy: 12-month low-dose CT, continue annual screening. New/enlarging (mean ≥ 1.5 mm/year) is graded more aggressively with shorter intervals; with suspicious features such as spiculation/lymph nodes → 4X., (2) Diagnostic approach: Imaging follow-up primary, no PET/biopsy needed; a single tumor marker is not recommended for tiny-nodule screening.）