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Nodule management plays a pivotal role in early detection and further diagnostic approaches. The European Society of Thoracic Imaging (ESTI) has established a nodule management recommendation to improve the handling of pulmonary nodules detected during screening. For solid nodules, the primary method for assessing the likelihood of malignancy is to monitor nodule growth using volumetry software. For subsolid nodules, the aggressiveness is determined by measuring the solid part. The ESTI-recommendation enhances existing protocols but puts a stronger focus on lesion aggressiveness. The main goals are to minimise the overall number of follow-up examinations while preventing the risk of a major stage shift and reducing the risk of overtreatment.<\/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>Assessment of nodule growth and management according to guidelines is essential in lung cancer screening<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Assessment of nodule aggressiveness defines follow-up in lung cancer screening<\/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>The ESTI nodule management recommendation aims to reduce follow-up examinations while preventing major stage shift and overtreatment<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-11648-4","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T14:02:42Z","timestamp":1751378562000},"page":"135-147","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["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\u2013private research project where Radboudumc collaborates with Philips Medical Systems and Siemens Healthineers. H.-U.K. received institutional research grants from Boehringer Ingelheim, Siemens 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. Mathias Prokop received speaker fees from Bracco, Bayer, Siemens, Canon and royalties from Canon. M.-P.R. receives benefits from AI solutions from Mevis, Coreline and DeepHealth, speaker fee from Bracco. 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"}}]}}