Diagnosis and management of pulmonary nodules

Abstract

There are an increased number of pulmonary nodules discovered on CT scan images in part due to those performed for lung cancer screening. Risk stratification and patient involvement is critical in determining management ranging from interval imaging to invasive biopsy or surgery. A definitive diagnosis requires tissue biopsy. The choice of a particular biopsy technique depends on the risks/benefits of the procedure, the diagnostic yield and local expertise. This review will focus on the evaluation and management of pulmonary nodules based on the Fleischner Society and American College of Chest Physician guidelines. There have been recent changes to both societies' recommendations for incidental detection of solid and subsolid nodules, risk stratification, imaging, minimally invasive diagnostic techniques and definitive surgical options.

Use of TBAg/PHA ratio in distinguishing tuberculoma from cancer in solitary pulmonary nodule or mass

“…6,22,23 CT screening also decreased the patients' quality life because it can bring some levels of fear and anxiety regarding future transformation to cancer. 16,26 In accordance with this recommendation, our data also showed that patient age, nodule size and nodule margin were significantly different between tuberculoma and cancer. Approximately 67 million CT are currently performed annually in the United States and this number will be likely to increase significantly in the coming years.…”

“…18,20 Thus, understanding how to differentiate between tuberculoma and malignancy in these indeterminate solitary pulmonary nodule or mass has become more and more important. 16 Additionally, although the early detection of pulmonary cancer by low-dose CT reduces the mortality, low-dose CT screening significantly increases the number of indeterminate solitary pulmonary nodule in asymptomatic individuals, leading to a substantial amount of overdiagnosis. 16 Additionally, although the early detection of pulmonary cancer by low-dose CT reduces the mortality, low-dose CT screening significantly increases the number of indeterminate solitary pulmonary nodule in asymptomatic individuals, leading to a substantial amount of overdiagnosis.…”

“…8 Although fluorodeoxyglucose (FDG) positron emission tomography (PET) has a high sensitivity in diagnosing pulmonary cancer, tuberculoma can demonstrate FDG accumulation as well. 16 Therefore, the non-invasive methods used for differentiation of tuberculoma from malignant nodule or mass are urgently needed, especially in tuberculosis-endemic areas. [13][14][15] The diagnostic accuracy is relatively high for invasive methods such as transthoracic needle biopsy, bronchoscopy and surgical resection.…”

Translational research in thoracic surgery—the National Taiwan University Hospital experience

“…Because of the prevalence of low dose chest computed tomography screening, multiple primary lung cancers (MPLCs) are detected more frequently than in the past (31). However, the genetic profile, treatment, and prognosis of patients remain unclear.…”

MicroRNAs in cancer therapeutics: “from the bench to the bedside”

“…A handful of pathologies have been associated with a higher probability of developing cancer, and some examples of these are: Barrett’s esophagus, metabolic syndrome, Lynch syndrome and solid pulmonary nodules (5–8). When studying premalignant diseases that predispose cancer development, recent focus has been centered on the role of miRNA expression in increasing the risk.…”