The solitary pulmonary nodule: Update 1995

Libby, Daniel M.; Henschke, Claudia I.; Yankelevitz, David F.

doi:10.1016/s0002-9343(99)80225-3

Cited by 37 publications

(27 citation statements)

References 9 publications

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“…Improvement of clinical/radiologic diagnosis of small lung tumors is essential if SBRT is used for clinically diagnosed Stage I lung cancer. Before the introduction of FDG-PET, the percentage of benign diseases in the solitary lung nodules detected by plain chest X-ray or CT was reported to be 25% to 50%, which is obviously too high (9)(10)(11)(12). However, improvement of imaging modalities has made it possible to diagnose small peripheral lung cancer much more precisely than before.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Stereotactic Body Radiotherapy for Small Lung Lesions Clinically Diagnosed as Primary Lung Cancer on Radiologic Examination

Inoue

Shimizu

Onimaru

et al. 2009

International Journal of Radiation Oncology*Biology*Physics

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Stereotactic Body Radiotherapy for Small Lung Lesions Clinically Diagnosed as Primary Lung Cancer on Radiologic Examination

Inoue

Shimizu

Onimaru

et al. 2009

International Journal of Radiation Oncology*Biology*Physics

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“…Most of the studies show that the incidence of malignant SPN ranges between 5–69% (average of 40%) 1 11 – 15. When lung cancer is the cause of SPN, adenocarcinoma is the most common pathology; on the other hand, small cell carcinoma is a rare cause of SPN 16 17. Carcinoid tumour accounts for 1–5% of malignant SPNs.…”

Section: Aetiology Of Solitary Pulmonary Nodulementioning

confidence: 99%

The evaluation and management of the solitary pulmonary nodule

Soubani

2008

Postgraduate Medical Journal

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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.

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“…Patients who have surgical resections for solitary nodules (pathological stage Ia or T1 N0, M0) have a 60-70% chance of surviving 5 years which is the reported outcome for lung cancer. [6][7][8] It is therefore important not to miss the opportunity for surgical cures. This concern may lead some clinicians to adopt a very aggressive surgical approach, despite published work suggesting that initially conservative management in this stage of disease does not adversely affect prognosis.…”

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confidence: 99%

Management of solitary pulmonary nodules: how do thoracic computed tomography and guided fine needle biopsy influence clinical decisions?

Baldwin

Eaton²,

Kolbe³

et al. 2002

Thorax

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Background: Computed tomography (CT) and fine needle guided biopsy (FNB) are often used in the assessment of patients with lung nodules. The influence of these techniques on clinical decision making has not been quantified, especially for small solitary pulmonary nodules (SPN) where the probability of malignancy is lower. A study was undertaken to determine the effect of CT and FNB derived information on clinical decision making in patients with a solitary pulmonary nodule < 3 cm in diameter on initial chest radiography. Methods: Clinical, physiological, and outcome data on 114 patients with an SPN < 3 cm who had subsequent thoracic CT and FNB were extracted from the records of a specialist cardiorespiratory hospital in Auckland, New Zealand. Chest radiographs and CT scans were reported according to specified criteria by a thoracic radiologist. Computer generated summary sheets were used to present cases to each of six clinicians. Each case was presented three times: (1) with clinical data and chest radiograph only; (2) with the addition of the CT report; and (3) with all data including the result of the FNB. Clinicians were asked to specify their management on each occasion and to estimate the probability of the lesion being malignant. Reproducibility was assessed by re-evaluating 24 cases 1 month later. Results: 33 (29%) nodules were benign, 35 (31%) nodules (malignant) were resected with negative node sampling, and 46 (40%) had a non-curative outcome (radiotherapy, incomplete resection, refused therapy). Intra-clinician decision making was consistent for all three levels of clinical data (median κ values 0.79-0.89). Agreement between clinicians on the need for surgery was lowest with chest radiography alone (κ=0.33), rose with CT information (κ=0.44), and increased further with the addition of the FNB data (κ=0.57). The proportion of successful decisions on surgical intervention (against the known outcome) increased with the addition of CT reports and further with FNB reports (p=0.006, Friedman's test). The major benefit of the information added by CT and FNB reports was a reduction in unnecessary surgery, especially when the clinical perception of pre-test probability of malignancy was intermediate (31-70%). FNB data contributed most to the benefit (p<0.001). The addition of CT and FNB was cost efficient and can be applied specifically to patients with a low or intermediate probability of malignancy. Conclusion: Both CT and FNB make cost effective contributions to the clinical management of SPN < 3 cm in diameter by reducing unnecessary operations and increasing agreement between physicians on the need for surgery.

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The solitary pulmonary nodule: Update 1995

Cited by 37 publications

References 9 publications

Clinical Outcomes of Stereotactic Body Radiotherapy for Small Lung Lesions Clinically Diagnosed as Primary Lung Cancer on Radiologic Examination

Clinical Outcomes of Stereotactic Body Radiotherapy for Small Lung Lesions Clinically Diagnosed as Primary Lung Cancer on Radiologic Examination

The evaluation and management of the solitary pulmonary nodule

Management of solitary pulmonary nodules: how do thoracic computed tomography and guided fine needle biopsy influence clinical decisions?

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