• Chest · Oct 2016

    Evaluation of pulmonary nodules: clinical practice consensus guidelines for Asia.

    • Chunxue Bai, Chang-Min Choi, Chung Ming Chu, Devanand Anantham, Chung-Man Ho James J Respiratory Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China., Ali Zamir Khan, Jang-Ming Lee, Shi Yue Li, Sawang Saenghirunvattana, and Anthony Yim.
    • Pulmonary Medicine Department, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, China. Electronic address: bai.chunxue@zs-hospital.sh.cn.
    • Chest. 2016 Oct 1; 150 (4): 877-893.

    BackgroundAmerican College of Chest Physicians (CHEST) clinical practice guidelines on the evaluation of pulmonary nodules may have low adoption among clinicians in Asian countries. Unique patient characteristics of Asian patients affect the diagnostic evaluation of pulmonary nodules. The objective of these clinical practice guidelines was to adapt those of CHEST to provide consensus-based recommendations relevant to practitioners in Asia.MethodsA modified ADAPTE process was used by a multidisciplinary group of pulmonologists and thoracic surgeons in Asia. An initial panel meeting analyzed all CHEST recommendations to achieve consensus on recommendations and identify areas that required further investigation before consensus could be achieved. Revised recommendations were circulated to panel members for iterative review and redrafting to develop the final guidelines.ResultsEvaluation of pulmonary nodules in Asia broadly follows those of the CHEST guidelines with important caveats. Practitioners should be aware of the risk of lung cancer caused by high levels of indoor and outdoor air pollution, as well as the high incidence of adenocarcinoma in female nonsmokers. Furthermore, the high prevalence of granulomatous disease and other infectious causes of pulmonary nodules need to be considered. Therefore, diagnostic risk calculators developed in non-Asian patients may not be applicable. Overall, longer surveillance of nodules than those recommended by CHEST should be considered.ConclusionsTB in Asia favors lesser reliance on PET scanning and greater use of nonsurgical biopsy over surgical diagnosis or surveillance. Practitioners in Asia are encouraged to use these adapted consensus guidelines to facilitate consistent evaluation of pulmonary nodules.Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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