On chest CT, a 2 cm pure ground-glass nodule (GGN) is identified in the right lower lobe. According to Lung-RADS 2022 guidelines, what is the appropriate management for a pure GGN measuring 2 cm detected at baseline screening CT?

• A Lung-RADS 1 — routine annual screening
• B Lung-RADS 3 — 6-month follow-up CT
• C Lung-RADS 4A — 3-month follow-up CT ✓
• D Lung-RADS 4B — PET-CT or tissue sampling

Explanation

Lung-RADS 2022 categorizes pure GGNs at baseline: <30 mm GGNs are Lung-RADS 2 (benign); GGNs ≥30 mm OR GGNs with a solid component are Lung-RADS 4A with 3-month follow-up CT recommended. A 20 mm pure GGN at baseline is Lung-RADS 3 (probably benign, 6-month follow-up CT). However, if the GGN is ≥30 mm at baseline, it is Lung-RADS 4A. At 20 mm (2 cm), this pure GGN is Lung-RADS 3 requiring 6-month follow-up, not routine annual screening or immediate tissue sampling. Options should be read carefully — 6-month CT is the answer for a 2 cm pure GGN.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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