LungRADSVersion1.

0AssessmentCategoriesReleasedate:April28,2014

Category

CategoryDescriptor

Category

Incomplete

Negative

Nonodulesand
definitelybenign
nodules

Management

Probabilityof
Malignancy

Estimated
Population
Prevalence

AdditionallungcancerscreeningCTimagesand/or
comparisontopriorchestCTexaminationsisneeded

n/a

1%

<1%

90%

6monthLDCT

12%

5%

3monthLDCT;PET/CTmaybeusedwhenthereis
a8mmsolidcomponent

515%

2%

chestCTwithorwithoutcontrast,PET/CTand/or
tissuesamplingdependingonthe*probabilityof
malignancyandcomorbidities.PET/CTmaybe
usedwhenthereisa8mmsolidcomponent.

>15%

2%

Findings
priorchestCTexamination(s)beinglocatedforcomparison
partoralloflungscannotbeevaluated

nolungnodules
nodule(s)withspecificcalcifications:complete,central,popcorn,concentric
ringsandfatcontainingnodules
solidnodule(s):
<6mm
new<4mm

Noduleswithaverylow

Benign
likelihoodofbecominga
Appearance
clinicallyactivecancerdue
orBehavior

Continueannualscreeningwith
LDCTin12months

partsolidnodule(s):
2

<6mmtotaldiameteronbaselinescreening
nonsolidnodule(s)(GGN):

tosizeorlackofgrowth

<20mmOR
20mmandunchangedorslowlygrowing
category3or4nodulesunchangedfor3months

Probably
Benign

Probablybenign
finding(s)shortterm
followupsuggested;
includesnoduleswitha
lowlikelihoodof
becomingaclinically
activecancer

solidnodule(s):
6to<8mmatbaselineOR
new4mmto<6mm
3

partsolidnodule(s)
6mmtotaldiameterwithsolidcomponent<6mmOR
new<6mmtotaldiameter
nonsolidnodule(s)(GGN)20mmonbaselineCTornew
solidnodule(s):
8to<15mmatbaselineOR
growing<8mmOR

4A

new6to<8mm
partsolidnodule(s:
6mmwithsolidcomponent6mmto<8mmOR

Suspicious

Findingsforwhich
additionaldiagnostic
testingand/ortissue
samplingis
recommended

withaneworgrowing<4mmsolidcomponent
endobronchialnodule
solidnodule(s)
15mmOR
4B

neworgrowing,and8mm
partsolidnodule(s)with:
asolidcomponent8mmOR

4X
ClinicallySignificantor
PotentiallyClinically
Other
SignificantFindings
(nonlungcancer)
Modifierforpatientswith
PriorLung apriordiagnosisoflung
cancerwhoreturnto
Cancer
screening

aneworgrowing4mmsolidcomponent
Category3or4noduleswithadditionalfeaturesorimagingfindingsthat
increasesthesuspicionofmalignancy

modifiermayaddontocategory04coding

Asappropriatetothespecificfinding

n/a

10%

modifiermayaddontocategory04coding

IMPORTANTNOTESFORUSE:
1)Negativescreen:doesnotmeanthatanindividualdoesnothavelungcancer
2)Size:nodulesshouldbemeasuredonlungwindowsandreportedastheaveragediameterroundedtothenearestwholenumber;forroundnodulesonlyasinglediametermeasurementisnecessary
3)SizeThresholds:applytonodulesatfirstdetection,andthatgrowandreachahighersizecategory
4)Growth:anincreaseinsizeof>1.5mm
5)ExamCategory:eachexamshouldbecoded04basedonthenodule(s)withthehighestdegreeofsuspicion
6)ExamModifiers:SandCmodifiersmaybeaddedtothe04category
7)LungCancerDiagnosis:Onceapatientisdiagnosedwithlungcancer,furthermanagement(includingadditionalimagingsuchasPET/CT)maybeperformedforpurposesoflungcancerstaging;thisisnolongerscreening
8)Practiceauditdefinitions:anegativescreenisdefinedascategories1and2;apositivescreenisdefinedascategories3and4
9)Category4BManagement:thisispredicatedontheprobabilityofmalignancybasedonpatientevaluation,patientpreferenceandriskofmalignancy;radiologistsareencouragedtousetheMcWilliamsetalassessmenttoolwhen
makingrecommendations
10)Category4X:noduleswithadditionalimagingfindingsthatincreasethesuspicionoflungcancer,suchasspiculation,GGNthatdoublesinsizein1year,enlargedlymphnodesetc
11)Noduleswithfeaturesofanintrapulmonarylymphnodeshouldbemanagedbymeandiameterandthe04numericalcategoryclassification
12)Category3and4AnodulesthatareunchangedonintervalCTshouldbecodedascategory2,andindividualsreturnedtoscreeningin12months
13)LDCT:lowdosechestCT
*LinktoMcWilliamsLungCancerRiskCalculator
Uponrequestfromtheauthorsat:http://www.brocku.ca/lungcancerriskcalculator
AtUptoDatehttp://www.uptodate.com/contents/calculatorsolitarypulmonarynodulemalignancyriskbrockuniversitycancerpredictionequation