Early detection is our most powerful tool in the fight against lung cancer — but only if we act on it.

‍

Each year, an estimated 1.6 million pulmonary nodules are identified in the United States, most of them discovered incidentally on CT scans ordered for other reasons. Most are initially labeled “low-risk,” and because surveillance for nodules under 6mm is considered optional under Fleischner Guidelines, they are often not followed. But new evidence suggests that this assumption is dangerously outdated.

‍

At the 2025 American Association for Bronchology and Interventional Pulmonology (AABIP) Conference, Dr. Scott Skibo, Eon’s Chief Medical Officer, presented findings that challenge long-held beliefs about risk progression in small nodules and highlight the need to implement systematic surveillance as a new clinical standard.

‍

When “Low-Risk” Doesn’t Stay Low

‍

In a retrospective analysis of 6,380 patients across 170 facilities, the data revealed a striking pattern: 26.2% of patients initially classified as low- or moderate-risk progressed to a higher risk category within just 12 months.

‍

Key clinical implications included:

‍

• 7.3% of patients with low-risk nodules (<6 mm) progressed to high risk within 12 months‍
• ‍9.4% of patients with moderate-risk nodules (6–8 mm) progressed to high risk
• 16.7% of the combined cohort showed overall progression to high risk — underscoring the need for system surveillance.

Size Alone Doesn’t Tell the Full Story

‍

Current surveillance guidelines prioritize follow-up for larger nodules. The 2017 Fleischner Society Guidelines classify 12-month CT surveillance for solid nodules under 6mm as optional in most cases.

‍

But every large, malignant nodule was once a smaller nodule that grew. Growth is one of the most reliable indicators of malignancy. The landmark NELSON trial showed nodules with rapid volume doubling time (≤400 days) had a 9.9% malignancy rate, compared with 0.8% for those with a doubling time of ≥600 days.

‍

Yet many surveillance strategies continue to treat sub-6mm nodules as benign until proven otherwise. The data tells a different story.

‍

Optional Follow-Up, Real-World Consequences

‍

If 7.3% of “low-risk” patients progress to high-risk within a year, is optional follow-up still defensible?

‍

Without systematic surveillance, we risk missing early-stage cancer — when intervention is most effective. Stage I lung cancer has a five-year survival rate of ~90%. By Stage IV, that drops to ~15%. Every missed follow-up is a missed opportunity for cure.

‍

The Cost of Delayed Diagnosis

‍

There is a common perception that monitoring small nodules places an unnecessary burden on already strained clinical resources. But the far greater cost — both financial and human — comes when cancer is detected too late.

‍

Surveillance offers a critical window of opportunity. For every 100 follow-up scans performed on patients with low- or moderate-risk nodules, roughly 17 reveal disease progression requiring closer management. Surveillance is not a drain on capacity; it is a high-value investment that helps health systems avoid the consequences of delayed diagnosis.

‍

In fact, research published in the Journal of Thoracic Oncology estimates the average cost of Stage I lung cancer care at $61,000, while Stage IV care costs nearly three times as much, approximately $184,000.

‍

Redefining the Standard of Care for Small Nodules

‍

The findings presented at AABIP compel a reevaluation of how incidental pulmonary nodules are managed:

‍

• Risk is not static — it can change quickly.
• “Optional” follow-up should be replaced with systematic protocols.
• Growth, not size alone, must be treated as the critical biomarker.

‍

Every small incidental nodule represents a chance to intercept lung cancer early, when outcomes are best and intervention is least invasive. Clinical practice must evolve to reflect that opportunity.

‍

View the research poster presented at AABIP 2025 for complete data and analysis.

‍