---
title: "Pulmonary Nodules: Classification, Risk Stratification, and Management"
id: "pubmed-42685318"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42685318"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42685318/"
doi: "10.1056/NEJMcp2515063"
published_at: "2026-09-03T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Pulmonary Nodules: Classification, Risk Stratification, and Management
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42685318
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42685318/)
- **DOI:** [10.1056/NEJMcp2515063](https://doi.org/10.1056%2FNEJMcp2515063)
- **Published At:** 2026-09-03T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Pulmonary nodules are categorized as **solid** or **subsolid**; subsolid nodules are further divided into **part-solid** and **pure ground-glass** types. - Management differs according to nodule type because growth patterns and malignant potential vary between solid and subsolid nodules. - Comparison with prior imaging is essential when available to determine interval change and malignancy risk. - Solid nodules that remain stable for 2 years are considered benign; subsolid nodules require a longer period of documented stability to be deemed benign. - **Prediction models** exist and can be applied to stratify the probability that a solid nodule is malignant; these models inform subsequent management decisions. - For low-risk nodules, **CT surveillance** is the recommended approach to monitor for change over time. - Intermediate-risk nodules are candidates for **positron-emission tomography–CT (PET-CT)**, biopsy, or both to obtain diagnostic information. - Selected high-risk nodules may proceed directly to **surgical resection**. - Subsolid nodules often grow more slowly than solid nodules but are associated with a higher overall risk of malignancy, particularly if a solid component appears or progressively enlarges. - Biopsy techniques described include **transthoracic needle biopsy** and **navigational bronchoscopy**. - Optimal management seeks a balance between achieving timely diagnosis for patients with cancer and avoiding unnecessary invasive procedures in patients with benign disease. - The review and recommendations summarize diagnostic imaging, pathology considerations, and procedural options relevant to solitary and multiple pulmonary nodules.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, United Kingdom. * 2 Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom. * 3 Thoracic Oncology Research Group, Hollings Cancer Center, Division of Pulmonary Medicine, Medical University of South Carolina, Charleston. * PMID: **42685318** * DOI: [ 10.1056/NEJMcp2515063 ](https://doi.org/10.1056/nejmcp2515063) Item in Clipboard Review # Pulmonary Nodules Matthew E J Callister et al. N Engl J Med. 2026. Show details Display options Display options Format Abstract PubMed PMID N Engl J Med Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22N+Engl+J+Med%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22N+Engl+J+Med%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42685318/) . 2026 Sep 3;395(9):894-905. doi: 10.1056/NEJMcp2515063. ### Authors [Matthew E J Callister](https://pubmed.ncbi.nlm.nih.gov/?term=Callister+MEJ&cauthor_id=42685318)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42685318/#short-view-affiliation-1 "Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, United Kingdom.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42685318/#short-view-affiliation-2 "Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom."), [Gerard A Silvestri](https://pubmed.ncbi.nlm.nih.gov/?term=Silvestri+GA&cauthor_id=42685318)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42685318/#short-view-affiliation-3 "Thoracic Oncology Research Group, Hollings Cancer Center, Division of Pulmonary Medicine, Medical University of South Carolina, Charleston.") ### Affiliations * 1 Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, United Kingdom. * 2 Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom. * 3 Thoracic Oncology Research Group, Hollings Cancer Center, Division of Pulmonary Medicine, Medical University of South Carolina, Charleston. * PMID: **42685318** * DOI: [ 10.1056/NEJMcp2515063 ](https://doi.org/10.1056/nejmcp2515063) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract Pulmonary nodules are classified as solid or subsolid, with subsolid nodules further classified as part-solid or pure ground-glass. Management strategies differ according to the type of nodule. A comparison of current and previous imaging studies, when available, is essential to assess the risk of the nodule being malignant. Solid nodules that have been stable for 2 years are considered to be benign, whereas subsolid nodules require a longer period of stability to be considered benign. Prediction models to stratify the risk of the nodule being malignant can be used to guide the management of solid nodules. Computed tomographic (CT) surveillance is indicated for low-risk nodules; positron-emission tomography-CT, biopsy, or both for intermediate-risk nodules; and surgical resection for selected high-risk nodules. Subsolid nodules are often slower growing than solid nodules but are associated with a higher risk of being malignant, especially if a solid component develops or progressively enlarges. Biopsy methods include transthoracic needle biopsy and navigational bronchoscopy. Optimal overall management balances timely diagnosis in persons who have cancer with the avoidance of unnecessary invasive procedures in persons who have benign disease. Copyright © 2026 Massachusetts Medical Society. 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