{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:44:47Z","timestamp":1791679487685,"version":"4.3.4"},"reference-count":91,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2012,2,1]],"date-time":"2012-02-01T00:00:00Z","timestamp":1328054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2012,2,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Integrating current evidence with fundamental concepts from decision analysis suggests that management of patients with pulmonary nodules should begin with estimating the pretest probability of cancer from the patient's clinical risk factors and computed tomography characteristics. Then, the consequences of treatment should be considered, by comparing the benefits of surgery if the patient has lung cancer with the potential harm if the patient does not have cancer. This analysis determines the \u201ctreatment threshold,\u201d which is the point around which the decision centers. This varies widely among patients depending on their cardiopulmonary reserve, comorbidities, and individual preferences. For patients with a very low probability of cancer, careful observation with serial computed tomography is warranted. For those with a high probability of cancer, surgical diagnosis is warranted. For patients in the intermediate range of probabilities, either computed tomography\u2013guided fine-needle aspiration biopsy or positron emission tomography, possibly followed by computed tomography\u2013guided fine-needle aspiration biopsy, is best. Patient preferences should be considered because the absolute difference in outcome between strategies may be small. The optimal approach to the management of patients with pulmonary nodules is evolving as technologies develop. Areas of uncertainty include quantifying the hazard of delayed diagnosis; determining the optimal duration of follow-up for ground-glass and semisolid opacities; establishing the roles of volumetric imaging, advanced bronchoscopic technologies, and limited surgical resections; and calculating the cost-effectiveness of different strategies.<\/jats:p>","DOI":"10.1164\/rccm.201104-0679ci","type":"journal-article","created":{"date-parts":[[2011,10,7]],"date-time":"2011-10-07T01:37:05Z","timestamp":1317951425000},"page":"363-372","source":"Crossref","is-referenced-by-count":202,"title":["Decision Making in Patients with Pulmonary Nodules"],"prefix":"10.1093","volume":"185","author":[{"given":"David E.","family":"Ost","sequence":"first","affiliation":[{"name":"Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael K.","family":"Gould","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2012,2,15]]},"reference":[{"key":"2026032101173434500_bib1","doi-asserted-by":"crossref","first-page":"2535","DOI":"10.1056\/NEJMcp012290","article-title":"Clinical practice: the solitary pulmonary nodule","volume":"348","author":"Ost","year":"2003","journal-title":"N Engl J Med"},{"key":"2026032101173434500_bib2","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1148\/radiology.182.2.1732947","article-title":"Solitary pulmonary nodule: CT evaluation of enhancement with iodinated contrast material\u2014a preliminary report","volume":"182","author":"Swensen","year":"1992","journal-title":"Radiology"},{"key":"2026032101173434500_bib3","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/S0025-6196(12)65012-5","article-title":"An integrated approach to evaluation of the solitary pulmonary nodule","volume":"65","author":"Swensen","year":"1990","journal-title":"Mayo Clin Proc"},{"key":"2026032101173434500_bib4","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1148\/radiol.2223010490","article-title":"Screening for early lung cancer with low-dose spiral CT: prevalence in 817 asymptomatic smokers","volume":"222","author":"Diederich","year":"2002","journal-title":"Radiology"},{"key":"2026032101173434500_bib5","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1164\/rccm.200301-144OC","article-title":"Lung cancer screening: a different paradigm","volume":"168","author":"McWilliams","year":"2003","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032101173434500_bib6","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1148\/radiol.2351041662","article-title":"CT screening for lung cancer: five-year prospective experience","volume":"235","author":"Swensen","year":"2005","journal-title":"Radiology"},{"key":"2026032101173434500_bib7","doi-asserted-by":"crossref","first-page":"2221","DOI":"10.1056\/NEJMoa0906085","article-title":"Management of lung nodules detected by volume CT scanning","volume":"361","author":"van Klaveren","year":"2009","journal-title":"N Engl J Med"},{"key":"2026032101173434500_bib8","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1148\/radiol.10091808","article-title":"The national lung screening trial: overview and study design","volume":"258","author":"National Lung Screening Trial Research Team","year":"2011","journal-title":"Radiology"},{"key":"2026032101173434500_bib9","article-title":"Statement concerning the national lung screening trial","author":"National Cancer Institute"},{"key":"2026032101173434500_bib10","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1056\/NEJMoa1102873","article-title":"Reduced lung-cancer mortality with low-dose computed tomographic screening","volume":"365","author":"Aberle","year":"2011","journal-title":"N Engl J Med"},{"key":"2026032101173434500_bib11","doi-asserted-by":"crossref","first-page":"108S","DOI":"10.1378\/chest.07-1353","article-title":"Evaluation of patients with pulmonary nodules: when is it lung cancer? 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