Imaging Lung Cancer and Pulmonary Nodules

Question 1

Primary lung cancer risk

Answer 1

Squamous and small cell much more with adenocarcinoma

Older age (30)

Asbestos

Pulm fibrosis/COPD

Genetics

Question 2

Squamous cell

Answer 2

30% of all cases
Strong smoking asosciated

Metastasize late

Relatively good (compared to other lung cancers)

65% arise centrally from main, lobar or segmental bronchi (atelectasis and consolidation are common)

30% as solitary nodule or mass (cavitation common)

Question 3

Adenocarcinoma

Answer 3

Most common

Smoking weakly associated (associated with lung fibrosis)

Metastasize early (adrenals and CNS)

Poor prognosis

75% in periphery

Common in upper

Solitary pulmonary nodule

Round lobulated and spiculated

Question 4

Adenocarcinoma in situ

Answer 4

Non invasive tumor characterized by lepidic growth

5% of malignancy

Great prognosis

60% as solitary noudle (non mucinous cell type…ill-defined nodule in a GG nodule…air bronchograms and cystic areas (pseudocavitation…GOOD))

40% as patchy condolidation (poorer prognosis, mucinous cell type, CT angiogram sign…POOR)

Question 5

SMall cell carcinoma

Answer 5

Neuroendocrine carcinoma

Paraneoplastic syndromes commonly associated

Terrible prognosis

3rd most common

Central, peribronchial invasion, large hilar or parahilar mass, bonrchial narrowing, LN enlargement

Question 6

Large cell carinoma

Answer 6

Strongly associated

Poor prognosis and metastasize early

Large peripheral masses

Similar to adenocarcinoma but larger at presentation

Question 7

Carcinoid tumor

Answer 7

Typical - low grade malgnancy…often in central bornchi, endobronchial mass, and locally invasive…most common in central lobar bronchi (obstrution findings)

Peripheral carcinoid - if typical, then well defined and present later

Atypial - more aggressive and nodal spread

Question 8

Pancoast

Answer 8

Superior sulcus tumor

Pain in shoulder
Radicular pain along eight ervical and first and second throacic nerves

Horners syndrome

Question 9

Nodules

Answer 9

Focal geographic growth in the lung measuring less than 3 cm

Spectrum of solid to semi solid to ground glass

Could be incidental
ONcology follow up or hx (think cancer)

Lung cancer screening

Question 10

Incidental nodules

Answer 10

Distinguish solid versus GGN

Review prior imaging…alsways consult with a radiologist

Question 11

Incidental nodules manageement

Answer 11

Step 1 - compare to priors, look for bengign features, rule out maignant distinguihs

Step 2 - if new and indeterminate, follow up with appropriate Fleischer recommendation

Question 12

Benign features

Answer 12

Calcified or fat

EPrifissural

Stable - Looks the same, Over 2 years (solid), 5-8 years (GGN)

Question 13

Lung cancer screening

Answer 13

Hx of smoking…look for nodules

1 annual low dose chest CT

Ages 55-74

30 or more pack years hx

Quit smoking over 15 years prior to enrollment