Approach to peripheral lung nodule

Question 1

Risk of malignancy with fleischner solid nodule < 6 mm

Answer 1

< 1%

Question 2

Risk of malignancy with fleischner solid nodule 6-8 mm

Answer 2

2%

Question 3

Risk of malignancy with fleischner solid nodule > 8 mm

Answer 3

3% at 8mm and increases from there

Question 4

Risk of malignancy with lung rads 1

Answer 4

< 1 %

Question 5

Risk of malignancy with lung rads 2

Answer 5

< 1%

Question 6

Risk of malignancy with lung rads 3

Answer 6

1-2%

Question 7

Risk of malignancy with lung rads 4A

Answer 7

5-15%

Question 8

Risk of malignancy with lung rads 4B

Answer 8

> 15%

Question 9

Radiographic size most associated with malignancy

Answer 9

> 2 cm

Question 10

Radiographic nodule types and risk of malignancy

Answer 10

Solid > part solid > GG

Question 11

Radiographic nodule number and risk of malignancy

Answer 11

1-4 increased risk to single nodule

> 5 nodules decreases risk

Question 12

Radiographic location of nodule associated with more malignancy risk

Answer 12

Upper lobe

Question 13

Spiculated or smooth edges of nodule more associated with malignancy?

Answer 13

Spiculated

Question 14

Emphysema more or less suggestive of malignancy for a nodule

Answer 14

More

Question 15

7 other characteristics that increase risk a nodule is malignant

Answer 15

Advanced age

Female

Prior history of malignancy

Smoking (35x increase)

Pseudocavitation

Vascular Convergance

Pleural retraction

Question 16

Risk calculator used for incidental nodules

Answer 16

Mayo

Question 17

Risk calculator used for screening found nodules

Answer 17

Brock

Question 18

SUV value on PET associated with increased malignancy risk

Answer 18

2 - 2.5

Question 19

4 causes of false negative on PET

Answer 19

Small nodule < 8 mm

GG or subsolid nodules

Slow growing adenocarcinomas

Carcinoids

Question 20

Study that showed 40% fewer procedures would be performed with liquid biopsy use

Answer 20

PANOPTIC in chest 2018

Question 21

4 calcification patterns associated with benign nodules

Answer 21

Popcorn

Fully

Laminated

Central

Question 22

2 calcification patterns that suggest a nodule is malignant

Answer 22

Eccentric

Speckled

Question 23

Average yield of BAL for malignancy

Answer 23

19%

Question 24

Average yield of Brush for malignancy

Answer 24

38%

Question 25

Average yield of TBBx for malignancy

Answer 25

43%

Question 26

Average yield of TBNA for malignancy

Answer 26

47%

Question 27

Is needle or forceps better for malignancy

Answer 27

needle

Question 28

Is needle or forceps better for benign lesions

Answer 28

forceps

Question 29

Registry that showed sensitivity of the various biopsy modalities

Answer 29

ACQuIRE registry

AJRCCM 2016

Question 30

Yield of biopsy with EBUS alone

Answer 30

57%

Question 31

Yield of biopsy with EMN alone

Answer 31

38%

Question 32

Yield of biopsy with EMN and REBUS combined

Answer 32

47%

Question 33

Study that showed EMN yield to be as high as 73%

Answer 33

NAVIGATE trial

JTO 2019

Question 34

Study that showed robot superior to other modalities for biopsy

Answer 34

PRECISION-1 study

CHEST 2020

Question 35

Yield of robotic bronchoscopy in PRECISION-1 trial

Answer 35

80%

Question 36

Study that showed segmental atelectasis in lower lobe segments with bronchoscopy and difficulty to distinguish on REBUS

Answer 36

I-LOCATE trial

Chest 2020

Question 37

Trial that showed recruitment maneuvers and higher peep decreased atelectasis

Answer 37

VESPA

Chest 2022