{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:10:00Z","timestamp":1789042200411,"version":"build-2803163510"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>\n                      The European Society of Thoracic Imaging (ESTI) nodule management recommendation for lung cancer screening with low-dose CT builds on existing nodule management guidelines but puts a stronger focus on lesion aggressiveness and measurement error. Key objectives included finding a compromise between the overall number of follow-up examinations, avoiding a major stage shift, and reducing the risk for overtreatment. Nodule management categories at baseline are chosen depending on the size of a solid nodule or the solid component of a subsolid or cystic nodule, with suspicious morphology upgrading risk to the next higher category. Higher risk categories mandate shorter follow-up times or diagnostic workup. Volume is the preferred size measure, with diameter measurements as a fallback if segmentation for volumetry is inaccurate at visual control. Nodule aggressiveness at follow-up is estimated from growth rate, calculated as volume doubling time (VDT), or yearly diameter change. Calculation of growth rate, however, is strongly affected by measurement variability, with large error margins for short follow-up and slower growing lesions. Growth thresholds were therefore set so that rapidly growing lesions can be identified while still small, while unnecessary workups for benign or slow-growing lesions could be kept low. New lesions that are retrospectively visible on earlier scans are managed according to their growth rate. New nodules not visible on earlier scans are followed after 3 months if they have a volume of \u2265\u200930\u2009mm\n                      <jats:sup>3<\/jats:sup>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>This work strives to reduce follow-up examinations while preventing major stage shift and overtreatment. It provides nodule management based on estimated nodule aggressiveness<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Calculation of the growth rate of pulmonary nodules is strongly affected by measurement variability, with large error margins for short follow-up and slower growing lesions<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Growth thresholds that trigger management are adjusted to the follow-up time so that rapidly growing lesions can be identified while still being small while unnecessary workups for benign or slow-growing lesions can be reduced<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-11647-5","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T14:02:38Z","timestamp":1751378558000},"page":"122-134","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Aggressiveness-guided nodule management for lung cancer screening in Europe\u2014justification for follow-up intervals and definition of growth"],"prefix":"10.1007","volume":"36","author":[{"given":"Mathias","family":"Prokop","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelia","family":"Schaefer-Prokop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Jacobs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2101-2783","authenticated-orcid":false,"given":"Annemiek","family":"Snoeckx","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Biederer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Frauenfelder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fergus","family":"Gleeson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Ulrich","family":"Kauczor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anagha P.","family":"Parkar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rozemarijn","family":"Vliegenthart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Pierre","family":"Revel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helmut","family":"Prosch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"key":"11647_CR1","doi-asserted-by":"publisher","unstructured":"Snoeckx A, Silva M, Prosch H et al (2025) Lung cancer screening with low-dose CT: definition of positive, indeterminate, and negative screen results. 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H.P. received institutional research grants and royalties from Boehringer Ingelheim, AstraZeneca, Siemens Healthineers and the Christian Doppler Research Association and the EU Commission (EU4Health, Horizon Europe Health) and received payments for lectures from AstraZeneca, BMS, Boehringer Ingelheim, Bracco, Daiichi Sankyo, Janssen, MSD, Novartis, Roche, Sanofi, Siemens Healthineers, Takeda. T.F. received speaker fees from Bracco, Boehringer, and Bayer. F.G. is a shareholder at Optellum Ltd and a Grant holder at Innovate UK\u2014enabling integrated diagnostics for early detection. C.J. received institutional research grants and royalties from MeVis Medical Solutions, Bremen, Germany, and received payments to the host institute for lectures from Johnson and Johnson Medical and Canon Medical Systems. C.J. is also an investigator in a public-private research project where Radboudumc collaborates with Philips Medical Systems and Siemens Healthineers. H.U.K. received institutional research grants from Boehringer Ingelheim, Siemans and Philips and received honoraria from Boehringer Ingelheim, Siemens, Philips, Sanofi, and Median. C.S.-P. received speaker fees from Bracco, Boehringer, Canon, and Philips and royalties from Elsevier and Thieme. M.P. received speaker fees from Bracco, Bayer, Siemens, Canon, and royalties from Canon. M.-P.R. received benefits from AI solutions from Mevis, Corelin, and DeepHealth, speaker fee from Bracco. R.V. received an institutional research grant from Siemens Healthineers and honorarium for lectures\/moderatorships from Wiley, Siemens Healthineers, and Bayer Healthcare. H.P. holds the position of Deputy Editor at European Radiology. C.J. and A.S. are members of the Scientific Editorial Board for European Radiology (sections: Imaging Informatics and Artificial Intelligence and Chest, respectively), and as such, they have not taken part in the review or selection processes for this article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"No complex statistical methods were necessary for this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was not required.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was not required.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}