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A Practical Algorithmic Approach to the Diagnosis and Management of Solitary Pulmonary NodulesDiagnosis of Solitary Pulmonary Nodules: Part 2: Pretest Probability and Algorithm

Vishal K. Patel, MBBS; Sagar K. Naik, MBBS; David P. Naidich, MD, FCCP; William D. Travis, MD, FCCP; Jeremy A. Weingarten, MD, FCCP; Richard Lazzaro, MD; David D. Gutterman, MD, FCCP; Catherine Wentowski, MD; Horiana B. Grosu, MD; Suhail Raoof, MBBS, FCCP
Author and Funding Information

From the New York Methodist Hospital (Drs Patel, Naik, Weingarten, Lazzaro, Wentowski, Grosu, and Raoof), Brooklyn, NY; New York University Langone Medical Center (Dr Naidich), New York, NY; Memorial Sloan-Kettering Cancer Center (Dr Travis), New York, NY; and Medical College of Wisconsin (Dr Gutterman), Milwaukee, WI.

Correspondence to: Suhail Raoof, MBBS, FCCP, New York Methodist Hospital, Department of Pulmonary and Critical Care, 506 Sixth St, Brooklyn, NY 11215; e-mail: suhailraoof@gmail.com


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(3):840-846. doi:10.1378/chest.12-1487
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In this second part of a two-part series, we describe an algorithmic approach to the diagnosis of the solitary pulmonary nodule (SPN). An essential aspect of the evaluation of SPN is determining the pretest probability of malignancy, taking into account the significant medical history and social habits of the individual patient, as well as morphologic characteristics of the nodule. Because pretest probability plays an important role in determining the next step in the evaluation, we describe various methods the physician may use to make this determination. Subsequently, we outline a simple yet comprehensive algorithm for diagnosing a SPN, with distinct pathways for the solid and subsolid SPN.

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