Respiratory and Sleep Medicine

Lung nodules

ADULT

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
No emergency indicators identified; routine prioritisation applies

Other useful information for referring practitioners Not an exhaustive list

Request for advice

Available to GPs who use GPSR and available at your local Health Service

Lung nodule(s) identified where:
- The GP requires further management advice
- Guidance is not available on HealthPathways
- The case does not clearly fit into any other referral categories
- Guidance is required in specific patient groups, such as the follow up of small pulmonary nodules (<6mm) in patients with a personal history of cancer.

Other Useful Information

Refer to HealthPathways or local guidelines.
National Lung Cancer Screening Program
Fleischner Society Guidelines 2017 | Timing for Follow-Up CT scans for incidental Lung Nodules¹

Type		Risk²	<6mm	6-8mm (≥6 for subsolid)
Solid	Single	Low	None	6-12 months then consider at 18-24 months
	Single	High	12 months (optional)	6-12 months then at 18-24 months
	Multiple	Low	None	3-6 months then consider at 18-24 months
	Multiple	High	12 months (Optional)	3-6 months then at 18-24 months
Non-solid			No routine follow-up	6-12 months then 2-yearly for 5 yrs
Part-solid			No routine follow-up	3-6 months then yearly for 5 yrs
Multiple			3-6 months then annual for 5 years	3-6 months then based on most suspicious

¹Not intended for patients <35 years, lung cancer screening, history of cancer or immunocompromised
²High-risk factors include older age, heavy smoking, irregular or spiculated margins, and upper lobe location.

Nodules that do not require referral include:
- Nodules with diffuse, central, laminated or popcorn patterns of calcification or macroscopic fat
- Juxtapleural (perifissural) nodules with characteristic triangular morphology < 10 mm diameter
- Solid nodules stable for at least 2 years
- Non-solid, part solid and atypical pulmonary cysts stable for at least 5 years

Review of previous imaging is very important to determine if nodules are new, enlarging, stable or decreased.
Follow up imaging of nodules should be performed at the same radiology service and on the same equipment, if possible.

Minimum Referral Criteria

Category 1
(appointment within 30 calendar days)

Lung nodules are traditionally defined as ≤30 mm in diameter. This section is relevant to both screening detected and incidental (scan performed for a different reason) lung nodules.

Any one of the following:

	Solid	Part Solid	Non-solid (Ground glass)
National Lung Cancer Screening Program	High Risk (Cat 5) or Very High Risk (Cat 6) nodules Calculated risk of malignancy >30%
Nodule Size¹	>8mm	Solid component >8mm
Nodule volume ²	≥268 mm³	Solid component ≥268 mm³
Change from previous scans (within 24 months)	Progressive growth over 3 or more scans Increase in size of >1.5 mm or volume of >25%	Progressive growth over 3 or more scans Solid component ≥4 mm or ≥34 mm³ which is new or growing	Doubling in size within 12 months
Other features	Growing nodule within a larger airway (segmental or more proximal) Progressive atypical cyst compared to previous scan(s) Regional lymphadenopathy Frank metastatic disease with no other obvious source

⁽¹⁾Dimensions are average of long and short axes, rounded to the nearest millimetre. Where only the largest diameter is provided in the imaging Report, this measurement can be considered
⁽²⁾ Volume calculated from radiology volumetric software.

Category 2
(appointment within 90 calendar days)

Any one of the following:

	Solid	Part Solid	Non-solid (Ground glass)
National Lung Cancer Screening Program	Moderate Risk (Cat 4) nodules where community follow up is not possible or where additional clinical risk factors are present.
Nodule Size¹	6-8 mm	Solid component 6-8 mm	≥30 mm
Nodule volume ²	≥113 to <268 mm³	Solid component 113 to <268 mm³
Change from previous scans (within 24 months)	Nodule 4 to <8 mm (113 to <268 mm³) which is new or growing	Solid component of nodule <4 mm (<34 mm³) which is new or growing	Doubling in size within 12 months
Other features	Nodule within a larger airway (segmental or more proximal) Atypical pulmonary cyst (multilocular or thick walled) Personal history of cancer - Request for Advice is available, if required, for small nodules that do not meet standard criteria.

⁽¹⁾Dimensions are average of long and short axes, rounded to the nearest millimeter. Where only the largest diameter is provided in the imaging Report, this measurement can be considered as a surrogate for the average.
⁽²⁾ Volume calculated from radiology volumetric software.

Category 3
(appointment within 365 calendar days)

There are no Category 3 criteria. Support for managing nodules <6 mm (that do not meet criteria for change from previous scans above) can be obtained by Request for Advice, if required.

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

Chest imaging and details of radiology provider
Details and pathology results (if available) of previous malignancies
NLCSP screening report, if applicable
Patient characteristics which influence risk of malignancy:
- Personal history of cancers
- Patient history, symptoms, and indication for CT (if CT performed for respiratory (infective) symptoms, consider short interval repeat CT depending on radiological likelihood of malignancy (e.g., 8–12 weeks)
- Detailed smoking history including tobacco, marijuana, electronic cigarettes, and illicit drugs
- Family history of lung cancer
- Ethnicity
- Occupational exposures
- Known underlying lung disease, for example, COPD, Interstitial lung disease
- Medications, for example, anticoagulation, immunosuppressive drugs

3. Additional referral information Useful for processing the referral

Historical imaging (if available)
FBC, ELFT and any other relevant pathology results

4. Request

Patient's Demographic Details
Full name (including aliases)
Date of birth
Residential and postal address
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Referring Practitioner Details
Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Relevant clinical information about the condition
Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use
Reason for request
To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary
Clinical modifiers
Impact on employment
Impact on education
Impact on home
Impact on activities of daily living
Impact on ability to care for others
Impact on personal frailty or safety
Identifies as Aboriginal and/or Torres Strait Islander
Other relevant information
Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
A change in patient circumstance (such as condition deteriorating or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 3 July 2025

Except as permitted under the Copyright Act 1968, no part of this work may be reproduced, communicated or adapted without permission from Queensland Health. To request permission email ip_officer@health.qld.gov.au¹.

Lung nodules

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

Request for advice

Other Useful Information

Lung nodules are traditionally defined as ≤30 mm in diameter. This section is relevant to both screening detected and incidental (scan performed for a different reason) lung nodules.

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

2. Essential referral information Referral will be returned without this

3. Additional referral information Useful for processing the referral

4. Request

Patient's Demographic Details

Referring Practitioner Details

Relevant clinical information about the condition

Reason for request

Clinical modifiers

Other relevant information

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.