Management of Lung-RADS Category 3 Findings

Definition and Inclusion Criteria

A Lung-RADS Category 3 finding on a low-dose CT scan indicates a probably benign nodule with a low likelihood (1-2%) of becoming a clinically active cancer, but requires follow-up imaging in 6 months to ensure stability, as recommended by the American College of Radiology 1, 2
Solid nodules measuring 6mm to <8mm in diameter are included in Lung-RADS Category 3, according to the American College of Radiology 1, 2
Part-solid nodules with the solid component <6mm in diameter are included in Lung-RADS Category 3, as per the American College of Radiology 1
New solid nodules 4mm to <6mm in diameter are included in Lung-RADS Category 3, based on guidelines from the American College of Radiology 1
New part-solid nodules <6mm in diameter are included in Lung-RADS Category 3, according to the American College of Radiology 1
Pure ground-glass nodules >30mm are included in Lung-RADS Category 3, as recommended by the American College of Radiology 1

Lung-RADS Category 3 nodules have approximately 1-2% probability of malignancy, according to guidelines from the American College of Radiology 1, 2

Current guidelines from the American College of Radiology recommend a follow-up chest CT scan 6 months after the nodule was identified 1, 2
For pure ground-glass nodules >30mm, a 6-month CT scan is recommended by the American College of Radiology 1
For part-solid nodules with solid component <6mm, a 6-month CT scan is recommended, as per the American College of Radiology 1
If the follow-up scan shows stability (no growth or concerning changes), then annual screening can resume, based on guidelines from the American College of Chest Physicians 3, 4

The American College of Chest Physicians recommends explaining to patients that their lung scan showed a small spot (nodule) that is most likely not cancer, and that these types of findings are common during lung screening 3
Patients should be informed that Category 3 findings have only about a 1-2% chance of being cancer, and that follow-up is essential, as recommended by the American College of Radiology 1, 2
The follow-up plan should be explained, including the importance of a 6-month follow-up scan to ensure the nodule isn't growing or changing, according to the American College of Radiology 1, 2

Structured reporting systems like Lung-RADS help standardize management and reduce unnecessary additional testing, as recommended by the American College of Chest Physicians 5

Causing unnecessary anxiety should be avoided by using clear and reassuring language while still emphasizing the importance of follow-up, as recommended by the American College of Chest Physicians 3
Minimizing the finding should be avoided, as follow-up is still essential, even though most Category 3 nodules are benign, according to the American College of Radiology 1, 2
Inconsistent follow-up intervals should be avoided, and adhering to the recommended 6-month follow-up timing is important for proper assessment, as recommended by the American College of Radiology 1, 2
Missing the follow-up should be avoided, and programs should develop strategies to maximize compliance with follow-up exams through reminders, education, and addressing barriers to returning for follow-up, according to the American College of Radiology 6