see treatment
Follow up of Screening findings
see LCS-7
LDCT in 6 mo
Annual LDCT
＜6mm
Screening
Annual screening LDCT until patient is no longer a candidate for definitive treatment
Biopsy orsurgical excision
see LCS-8
initiation screening LDCT
≥15mm
stable
LDCT in 3 mo
Cancer confirmed
＞20mm
or
Chest CT± contrast and/or PET/CT
＞15mm
unchanged
1.Smoking history2.Radon exposure3.Occupational exposure4.Cancer history5.Family history of Lung cancer in first degree relatives.6.Disease history（COPD or pulmonary fibrosis） 7.Smoking exposure8.Absence of symptoms or signs of lung cancer 9.Lung cancer survivors
Surgical excision
Lung cancer screening not recommeded
≥8mm
unchanged on follow-up LDCT
see LCS-9
OR
＜20mm
new
Low suspicion of lung cancer
Non-solid nodule
Moderate Risk：
Consider PET/CT
No cancer
Multiple non-solid nodule
≥6mm with growing ＜4mm solid component
new or growing
Risk Status
1.Age ≥50y and2.≥20 pack-year history of smoking and 3.additional risk factors （other than second hand smoking）
High suspicion of lung cancer
Solid nodule
solidendobronchialnodule
≥6mm with 6-8mm solid component
follow up or annual screening LDCT
8-15mm
Pure non-solid nodules
unchanged on annual LDCT
＜8mm
1.Age 55-74 y and2.≥30 pack-year history of smoking and3.smoking cession ＜ 15y（category 1）
6-8mm
Consider biopsy
Stable
4-6mm
Low Risk：
LDCT in 1 mo immediately after vigorous coughing
＜4mm
1.Age ≥50 y and2.≥20 pack-year history of smoking or second hand smoking exposure and 3.No additional risk factors
≥6mm with ≥8mm solid component
In candidates for screening，shared patient/physician decision making is recommended ，including a discussion of benefits/risks
growing
Part-solid nodule
Lung nodules
PET/CT
Solid component ＞8mm
Risk Assessment
Yes
manage the largest nodule and manage base on LCS4 or LCS8
Low dose CT（category 1）
1.Age ＜50y and/or2.＜20 pack-year history of smoking
Dominant nodule(s) with part-solid component
≥4mm solid component
No
≥6mm with solid component 6-8mm
Growing
Low dose CT
Evaluation of screening findings
Bronchoscopy
manage the largest nodule and manage base on LCS5 or LCS9
≥6mm with solid component ＜6mm
High Risk：
≥20mm
If no resolution
