The evaluation and management of the solitary pulmonary nodule

Abstract

Solitary pulmonary nodules (SPNs) are increasingly detected with the widespread use of chest computed tomography (CT) scans. The primary goal of the evaluation of these nodules is to determine whether they are malignant or benign. Clinical factors such as older age, tobacco smoking and current or remote history of malignancy increase the pre-test likelihood of malignancy. Radiological features of the SPN based on chest CT with high resolution cuts are critical in differentiating between benign or malignant lesions. These features include size, change in size, the presence and pattern of calcification, edge characteristics, attenuation, and contrast enhancement. SPNs that are stable in size for >2 years and those with benign pattern of calcification do not need further studies. Lesions with clear change in size are malignant until proven otherwise and require tissue diagnosis. Frequently, the aetiology of the SPN following chest CT scan remains indeterminate and requires further evaluation. The approach to the management of indeterminate SPN ranges between observation with repeat chest CT scan, further diagnostic studies such as positron emission tomography (PET) scan, or invasive procedures to obtain tissue diagnosis. These procedures include bronchoscopy, transthoracic needle aspirate, and resection by video assisted thoracoscopy or thoracotomy. Determination of which approach to follow depends on the pre-test probability of malignancy, whether the patient is a surgical candidate, and the patient's informed preferences. This article reviews the radiological features of the SPN and their value in differentiating between benign and malignant lesions. This is followed by discussion of the different approaches to the management of the SPN after initial characterisation by chest CT scan, including the benefits and limitations of the different diagnostic studies.

Size of tumour as a risk factor for malignancy in patients with peripheral pulmonary nodules

“…This problem is often hard to solve depending, as it does, on many other factors. 11,12 In the present study we set to fi nd if there is a correlation between the size of the tumour and its malignancy and if the answer is positive whether we can use it as a prognostic factor so that a timely and accurate diagnosis can be made.…”

A case of typical pulmonary carcinoid tumor treated with bronchoscopic therapy followed by lobectomy

“…The diagnosis of carcinoid pulmonary tumor is established on the basis of the patient’s symptoms combined with imaging examination such as chest radiography, computed tomography and magnetic resonance imaging 12. To verify the histologic type of the pulmonary tumor detected, there are several biopsy options including bronchoscopic biopsy, needle biopsies and surgical biopsies (eg, thoracotomy) 13.…”

PET/CT en cáncer pulmonar

“…Los nódulos pulmonares únicos o múltiples son hallazgos de gran frecuencia tanto en pacientes fumadores como no fumadores 32,33 , y su detección se ha optimizado notablemente con la aparición de equipos de tomografía computada multidetectores, que permiten una adquisición volumétrica rápida con cortes de grosores cercanos a 1 mm. La significación de dichos nódulos tiene estrecha relación con factores clínicos (edad del paciente, hábito tabáquico, enfermedad maligna conocida), y con las características propias del nódulo (tamaño, bordes espiculados, ubicación en lóbulos superiores, etc) 34 . Existen múltiples modelos que se han propuesto en el estudio y seguimiento de los nódulos pulmonares, incluyendo la mayoría de ellos la TC y el PET, además de procedimientos de tipo invasivo, con seguimiento imagenológico por al menos 2 años [34][35][36] .…”

“…La significación de dichos nódulos tiene estrecha relación con factores clínicos (edad del paciente, hábito tabáquico, enfermedad maligna conocida), y con las características propias del nódulo (tamaño, bordes espiculados, ubicación en lóbulos superiores, etc) 34 . Existen múltiples modelos que se han propuesto en el estudio y seguimiento de los nódulos pulmonares, incluyendo la mayoría de ellos la TC y el PET, además de procedimientos de tipo invasivo, con seguimiento imagenológico por al menos 2 años [34][35][36] . Algunos autores han destacado la utilidad de otros estudios de menor uso clínico en el estudio de nódulos pulmonares, como la RM y SPECT Tc99m-depreotide, describiendo rendimientos similares al estudio metabólico 37 .…”