According to the guideline, multiple pulmonary nodules are recommended to be evaluated individually for each nodule and to be screened for a predominant nodule (the predominant nodule is the most suspicious nodule, which is not necessarily the largest nodule). The management of multiple pulmonary nodules should, in principle, be based on the clinical strategy of the dominant nodule.
1. For multiple solid lung nodules, lung metastases, infectious granulomas (e.g., tuberculosis, fungi), and non-infectious granulomas should be considered. PET-CT can help to determine the metastatic nodules and their primary foci, which is of value in the diagnosis and management of multiple lung nodules; and in most cases, the metastatic foci can be clearly observed to have enlarged within 3 months.
2. For multiple sub-solid lung nodules, multiple primary lung cancers, infectious inflammation and non-infectious inflammation should be considered. If the lesion is not significantly reduced, faded or absorbed after the first follow-up CT at 3 months, the possibility of multiple primary lung cancers should be considered; however, there are limitations in the determination of multiple sub-solid lung nodules by PET-CT.
3. MDT (multidisciplinary consultation) is recommended when there are difficulties in categorizing multiple lung nodules and adopting optimal treatment.
If multiple nodules are found, please consult the hospital in time and choose the appropriate way to deal with multiple pulmonary nodules under the guidance of doctors.