Incidental lung nodule reported. What do I do next?

AKASH VERMA Senior Consultant Respiratory and Critical Care Medicine Mount Elizabeth Medical Centre ABSTRACT A lung nodule (white spot < 3 cm in diameter) can either be first detected on a chest radiograph or a Computed Tomography (CT) scan. When detected on the radiograph, the next step is almost always a CT scan. When first detected on a CT scan, the next step is the comparison with any imaging studies available from the past. If no past imaging is available for comparison, then the next step is a biopsy, which is also the gold standard for diagnosis. Although observation with interval imaging has been advocated, this approach is only safe when the likelihood of the nodule being benign is very high. Otherwise, a biopsy should be undertaken to exclude or confirm cancer in the early stage as it carries implications for survival.