BTS 2015 Pulmonary Nodule Guideline Navigator

The BTS 2015 guideline (Callister, Thorax, NICE-accredited) departs from Fleischner by removing smoking-history stratification for small nodules and by driving larger-nodule management with two validated prediction models. Solid nodules below 5 mm (or 80 mm³) are discharged; 5 to <8 mm (or 80–<300 mm³) enter CT surveillance with volumetric doubling-time assessment (3-month and 1-year CT for nodules ≥6 mm or ≥80 mm³; 1-year CT for 5–<6 mm; discharge if stable at 1 year, or after 2 years of 2D follow-up). Solid nodules ≥8 mm (or ≥300 mm³) are assessed with the Brock model: below 10% go to surveillance, at or above 10% to PET-CT with Herder re-assessment, then surveillance (<10%), consideration of image-guided biopsy (10–70%), or surgical resection (>70%). Subsolid nodules below 5 mm need no follow-up; larger ones are re-scanned with thin-section CT at 3 months, and persistent ones are Brock-stratified to CT at 1, 2 and 4 years (~<10%) or a discussion of observation, biopsy and treatment (~>10%). Ground-glass nodules enlarging by ≥2 mm, and part-solid nodules with a growing or new solid component, are escalated toward resection or non-surgical treatment.