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Fleischner 2017 (solid pulmonary nodule)

Indicates follow-up for solid pulmonary nodules found incidentally on CT in adults aged 35 or older, based on size, nodule count and patient risk.

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Method · Limits of application

Fleischner Society 2017: incidental solid nodules, rounded mean diameter; exclusions preserved

Variant for incidentally detected solid pulmonary nodules in adults aged 35 years or older. The Fleischner 2017 recommendations do not apply to lung cancer screening, immunocompromised people or patients with known primary cancer. Subsolid or part-solid nodules require a different algorithm. For multiple nodules, the most suspicious nodule should guide assessment; it is not necessarily the largest. Risk stratification and the follow-up decision depend on clinical and radiological assessment.

Conditions of use

Check the population, units, inclusion and exclusion criteria, and version in the original source. A result alone does not establish a diagnosis, discharge decision or prescription.

Documented parameters

Mean nodule diameter (most suspicious nodule if there are several) · mm
Number of nodules
Lung cancer risk

4/4 reference cases checked. Numerical tests are not clinical validation.

Sources and documentation

Documented formula

Transcribed from the source or a recorded revision; this is not a clinical recommendation.

Mean diameter = (longest axis + shortest axis) ÷ 2, rounded to the nearest millimetre. Ranges: < 6 mm (< 100 mm³), 6 to 8 mm (100 to 250 mm³) and > 8 mm (> 250 mm³).

References

Identifier: fleischner-2017

Original clinical content: Brazilian Portuguese.

Method version

Fleischner Society 2017: incidental solid nodules, rounded mean diameter; exclusions preserved

fleischner-2017@native-2026-10-03+51f7a6ebe7e9

Source for the active edition

The bibliographic edition identifies the source. By itself, it proves neither full conformity of the formula nor clinical approval.

Synthetic cases checked (4)

Synthetic cases for checking the implementation, with no patient data.

Case 1

reference-001

Inputs

Mean nodule diameter (most suspicious nodule if there are several): 4 mm
Number of nodules: Single
Lung cancer risk: Low

{
  "tamanho": 4,
  "num": "u",
  "risco": "b"
}

Expected result

{
  "level": "low",
  "verdict": "Sem seguimento de rotina"
}

Actual result

{
  "mm": 4,
  "cat": "< 6 mm"
}

Case 2

reference-002

Inputs

Mean nodule diameter (most suspicious nodule if there are several): 5.6 mm
Number of nodules: Single
Lung cancer risk: High (smoking, age, exposure, family history, emphysema, upper lobe)

{
  "tamanho": 5.6,
  "num": "u",
  "risco": "a"
}

Expected result

{
  "mm": 6
}

Actual result

{
  "mm": 6,
  "cat": "6 a 8 mm"
}

Case 3

reference-003

Inputs

Mean nodule diameter (most suspicious nodule if there are several): 7 mm
Number of nodules: Multiple
Lung cancer risk: Low

{
  "tamanho": 7,
  "num": "m",
  "risco": "b"
}

Expected result

{
  "level": "mid",
  "verdict": "TC em 3 a 6 meses; depois, considerar"
}

Actual result

{
  "mm": 7,
  "cat": "6 a 8 mm"
}

Case 4

reference-004

Inputs

Mean nodule diameter (most suspicious nodule if there are several): 10 mm
Number of nodules: Single
Lung cancer risk: Low

{
  "tamanho": 10,
  "num": "u",
  "risco": "b"
}

Expected result

{
  "level": "high",
  "verdict": "PET-TC"
}

Actual result

{
  "mm": 10,
  "cat": "> 8 mm"
}

Code and reproducibility

This tool’s code on GitHub

Download code and tests

Sources, version and reproduction instructions

The code tests are technical checks. Clinical approval and professional translation review are recorded separately.

Relationship with cancer research

Specific oncological application

A reference for incidental lung nodules in eligible adults. Do not extrapolate to organized screening, immunosuppression or patients with known cancer.

Applications: Early detection and risk assessment