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Michael K. Gould, MD, FCCP; Renda Soylemez Wiener, MD, MPH
Author and Funding Information

From the Department of Research and Evaluation (Dr Gould), Kaiser Permanente Southern California; The Pulmonary Center (Dr Wiener), Boston University School of Medicine; and Center for Healthcare Organization and Implementation Research (Dr Wiener), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA.

Correspondence to: Michael K. Gould, MD, FCCP, Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Ste 304, Pasadena, CA 91101; e-mail: michael.k.gould@kp.org


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Gould has grant support from the National Cancer Institute to study computerized decision support for lung nodule evaluation [R01-CA117840]. Dr Wiener is supported by a career development award from the National Cancer Institute [K07-CA138772].

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


Chest. 2013;144(5):1742. doi:10.1378/chest.13-2027
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To the Editor:

We thank Dr Kakinuma and colleagues for their interest in the third edition of the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines for the diagnosis and management of lung cancer.1 They correctly point out some differences between the ACCP guidelines and the recommendations of the Fleischner Society for the evaluation of patients with subsolid nodules.1,2 The ACCP guidelines definition of nodule size refers to the widest nodule diameter, as is most commonly reported in clinical practice. For both nonsolid (pure ground glass) and part-solid nodules, the thresholds refer to the entire nodule because delineation of solid and nonsolid components may be especially challenging in usual practice settings, and documentation rarely is complete.

Regarding window settings and other technical aspects of measurement by radiologists, we defer to the Fleischner Society recommendations. In hindsight, the language in our remark about proceeding directly to further evaluation in patients with part-solid nodules measuring > 15 mm in diameter may have been too strong. It is not unreasonable to repeat chest CT scanning in 3 months in such patients, although the evidence in support of this practice is only anecdotal.

References

Gould MK, Donington J, Lynch WR, et al. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5_suppl):e93S-e120S. [CrossRef] [PubMed]
 
Naidich DP, Bankier AA, MacMahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology. 2013;266(1):304-317. [CrossRef] [PubMed]
 

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References

Gould MK, Donington J, Lynch WR, et al. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5_suppl):e93S-e120S. [CrossRef] [PubMed]
 
Naidich DP, Bankier AA, MacMahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology. 2013;266(1):304-317. [CrossRef] [PubMed]
 
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