IMPORTANCE Pulmonary nodules are identified in approximately 1.6 million patients per year in the US and are detected on approximately 30% of computed tomographic (CT) images of the chest. Optimal treatment of an individual with a pulmonary nodule can lead to early detection of cancer while minimizing testing for a benign nodule. OBSERVATIONS At least 95% of all pulmonary nodules identified are benign, most often granulomas or intrapulmonary lymph nodes. Smaller nodules are more likely to be benign. Pulmonary nodules are categorized as small solid (<8 mm), larger solid (≥8 mm), and subsolid. Subsolid nodules are divided into ground-glass nodules (no solid component) and part-solid (both ground-glass and solid components). The probability of malignancy is less than 1% for all nodules smaller than 6 mm and 1% to 2% for nodules 6 mm to 8 mm. Nodules that are 6 mm to 8 mm can be followed with a repeat chest CT in 6 to 12 months, depending on the presence of patient risk factors and imaging characteristics associated with lung malignancy, clinical judgment about the probability of malignancy, and patient preferences. The treatment of an individual with a solid pulmonary nodule 8 mm or larger is based on the estimated probability of malignancy; the presence of patient comorbidities, such as chronic obstructive pulmonary disease and coronary artery disease; and patient preferences. Management options include surveillance imaging, defined as monitoring for nodule growth with chest CT imaging, positron emission tomography-CT imaging, nonsurgical biopsy with bronchoscopy or transthoracic needle biopsy, and surgical resection. Part-solid pulmonary nodules are managed according to the size of the solid component. Larger solid components are associated with a higher risk of malignancy. Ground-glass pulmonary nodules have a probability of malignancy of 10% to 50% when they persist beyond 3 months and are larger than 10 mm in diameter. A malignant nodule that is entirely ground glass in appearance is typically slow growing. Current bronchoscopy and transthoracic needle biopsy methods yield a sensitivity of 70% to 90% for a diagnosis of lung cancer. CONCLUSIONS AND RELEVANCE Pulmonary nodules are identified in approximately 1.6 million people per year in the US and approximately 30% of chest CT images. The treatment of an individual with a pulmonary nodule should be guided by the probability that the nodule is malignant, safety of testing, the likelihood that additional testing will be informative, and patient preferences.

中文翻译：

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评估患有肺结节的患者：回顾。

重要性在美国每年约有 160 万患者发现肺结节，大约 30% 的胸部计算机断层扫描 (CT) 图像可以检测到肺结节。对患有肺结节的个体进行最佳治疗可以早期发现癌症，同时最大限度地减少对良性结节的检测。观察 至少 95% 的肺结节是良性的，最常见的是肉芽肿或肺内淋巴结。较小的结节更有可能是良性的。肺结节分为小实性（<8 mm）、大实性（≥8 mm）和亚实性。亚实性结节分为毛玻璃结节（无实性成分）和部分实性（既有毛玻璃又有实性成分）。所有小于 6 mm 的结节发生恶性肿瘤的可能性小于 1%，对于 6 mm 至 8 mm 的结节，发生恶变的可能性为 1% 至 2%。6 至 8 毫米的结节可在 6 至 12 个月内复查胸部 CT，具体取决于患者是否存在与肺部恶性肿瘤相关的风险因素和影像学特征、对恶性肿瘤概率的临床判断以及患者偏好。实性肺结节 8 mm 或更大的个体的治疗基于估计的恶性肿瘤概率；患者合并症的存在，例如慢性阻塞性肺病和冠状动脉疾病；和患者偏好。管理选择包括监测成像，定义为通过胸部 CT 成像监测结节生长、正电子发射断层扫描-CT 成像、使用支气管镜检查或经胸穿刺活检的非手术活检以及手术切除。部分实性肺结节根据实性成分的大小进行管理。较大的固体成分与较高的恶性肿瘤风险相关。当磨玻璃肺结节持续超过 3 个月且直径大于 10 mm 时，其恶性概率为 10% 至 50%。外观完全为毛玻璃的恶性结节通常生长缓慢。目前的支气管镜检查和经胸穿刺活检方法对肺癌诊断的敏感性为 70% 至 90%。结论和相关性在美国每年约有 160 万人发现肺结节，约占胸部 CT 图像的 30%。肺结节患者的治疗应以结节为恶性的概率、检测的安全性、