Incidental nodules

Question 1

Pro/con of Brock model for assessing risk of malignancy

Answer 1

Good sen
incorporates nodule attenuation

Con: only estimates for high risk population. Overest in low risk pop

Question 2

Veterans Admin Cooperative model for predicting malignancy limitation

Answer 2

Only validated in high risk pop

Question 3

Mayo Clinic Model

Answer 3

Based on CXR
more accurate for general population

Question 4

When is a nodule stable?

Answer 4

Solid–> stable >24mo on CT
Subsolid –> stable >/= 5 years

Question 5

4 benign patterns of calcification

Answer 5

Likely from prior infection:
- central
- diffuse
- lamellated

Hamartoma:
popcorn

Question 6

Probability of malignancy ranges

Answer 6

Low - <5%
Intermediate - 5-65%
High- >65%

Question 7

Solitary solid nodule >8mm next steps depending on risk

Answer 7

Low risk– CT at 3 mo – unchanged then 9mo CT–> unchanged then 24 mo CT
Intermediate– PET/CT
High– biopsy or excision

Question 8

solitary solid or subsolid nodules measuring <6 mm in size in patients without risk factors next steps

Answer 8

No follow up required

optional if risk factors present - 12 mo and only if grown then biopsy

Question 9

Solitary Solid nodule 6 to 8 mm next steps

Answer 9

CT chest 6-12 mo

PET and biopsy not helpful at that size

Question 10

Solitary Solid nodule 6 to 8 mm next steps after 6-12 mo follow up CT

Answer 10

1. nodule growth –> resection or biopsy
2. Resolved –> done
3. unchanged–> assess risk malignancy
   - Low –> done
   - High or intermediate –> Chest CT 18-24 mo

Question 11

Multiple solid <6mm nodules in low risk pt

Answer 11

No need for follow up

Question 12

Multiple solid <6mm nodules in High or moderate risk pt

Answer 12

optional CT at 12mo

Question 13

Multiple solid >/= 6mm nodules in High or moderate risk pt

Answer 13

CT 3-6 mo then CT 18-24mo

Question 14

Multiple solid >/= 6mm nodules in Low risk pt

Answer 14

CT at 3-6 mo then MAYBE CT 18-24

Question 15

Incidental solitary subsolid nodule <6mm ggo or part solid

Answer 15

No additional follow up

Question 16

Incidental solitary subsolid nodule >/=6mm ground glass

Answer 16

CT chest 6-12 mo then every 2 years for up to 5 years

• if grows –> biopsy or resect
• done if resolves

Question 17

Incidental solitary subsolid nodule >/=6mm PART SOLID

Answer 17

CT chest 3-6 mo

• persistent part solid >8mm then biopsy or resect
• if <8mm then annual CT chest for 5 years or resolution

Question 18

Incidental multiple pulmonary nodules solid or subsolid next steps

Answer 18

Get full CT

Management based on most suspicious nodule (largest or part solid or one with most solid component)

Assess size. <6 or >= 6mm

Assess likelihood of malignancy

Question 19

Incidental multiple pulmonary nodules solid or subsolid <6mm next step

Answer 19

no further follow up

Question 20

Incidental multiple pulmonary nodules solid or subsolid >/= 6mm, next steps

Answer 20

CT chest 3-6mo

Question 21

Incidental multiple pulmonary nodules solid or subsolid >/= 6mm, next steps after CT chest 3-6mo if unchanged and solid

Answer 21

High risk –> CT at 9 mo and then 24 mo
Low risk –> no follow up

Question 22

Incidental multiple pulmonary nodules solid or subsolid >/= 6mm, next steps after CT chest 3-6mo if unchanged and SUBsolid

Answer 22

Ask if nodule is ground glass vs. part solid?
Also look at size. <6mm?

<6mm– No follow up

> /= 6mm ground glass -> Chest CT 6-12mo then every 2 years for up to 5 years

> /= part solid–> CT chest 3-6 mo –> if solid portion <8mm then annual CT for 5 yr
- if >8mm sample

Question 23

Lung RADS 1 meaning

Answer 23

No lung nodules
OR
Nodule with benign features (calcification patter or fat)

Question 24

Lung RADS 2

Answer 24

Benign – 12 month LDCT

Question 25

Lung RADS 3

Answer 25

Probably benign - 6 mo LDCT

Question 26

Lung RADS 4A

Answer 26

Suspicious –> 3 mo LDCT or PET if >/= 8mm nodule

Question 27

Lung RADS 4B

Answer 27

Very suspicious –> PET or CT chest likely biopsy