Narrative review of classification and management of solitary pulmonary nodule: the state of art

Objective: Solitary pulmonary nodule (SPN) is defined as a lung lesion less than 30 mm in diameter. The etiology of SPNs is generally benign, however, they may represent an early malignant process. This article aims to provide an overview of the management of SPN, including clinical and radiological evaluation. Background: SPN has frequently been encountered during clinical practice and its management poses a challenge for clinicians. Clinical assessment and computed tomography (CT) features are important to establish the correct diagnostic pathway for patients. Evaluation of the pulmonary nodule requires an integrated approach in order to reveal an early malignancy and to prevent health-damaging diagnostic over investigations. Nodule size, volume doubling time (VDT), margin characteristics, location and composition help identify behavior of pulmonary nodules and should guide decision regarding biopsy, positron emission tomography (PET)/CT and/or CT surveillance. Benign conditions should also be considered in the diagnostic evaluation. Quantitative prediction models have been developed in order to estimate the probability of malignancy, and guidelines provide accurate diagnostic algorithms for pulmonary nodule management. Methods: This review was performed by finding the most relevant articles regarding the management and treatment of SPN. We searched the PubMed and MEDLINE platforms including only articles in English, and then an extensive literature review was done. Conclusions: Current guidelines provided detailed recommendations on the decision-making of the pulmonary nodule. Moreover, several clinical studies have evaluated the effectiveness low-dose computed tomography (LDCT) as a screening method, as early detection of lung cancer could have a higher curative potential. In this review, we discuss the overall management of patients with SPN and we summarize the highlights of the main guidelines in this regard.