Manejo de Nódulos Pulmonares Incidentais na CT

Question 1

Limitações da Diretriz

Answer 1

Não serve pra pcts imunosup
Não serve pra adultos mais jovens que 35
Não serve pra pcts com câncer primário com suspeita de metástase

Question 2

Cuidados quanto a espessura das secções do TC

Answer 2

All CT scans of the thorax in adults
should be reconstructed and archived
with contiguous thin sections (<1.5 mm, typically 1.0 mm) to enable accurate characterization and measurement
of small pulmonary nodules, and routine acquisition and archiving of off-axis (coronal and sagittal) reconstructed
series is strongly recommended

Question 3

É importante sempre comparar um TC com outros TCs anteriores? Pq?

Answer 3

Prior imaging studies should always
be reviewed whenever they are available
to determine possible growth or stability.

Question 4

Conduta para nódulos sólidos menores que 6mm

Answer 4

Baixo risco: não precisa acompanhar (risco menor que 1%)
Alto risco: Geralmente não precisa acompanhar (OBS: some nodules smaller than 6 mm with suspicious morphology, upper lobe location, or both may warrant follow-up at
12 months )

Question 5

Conduta para nódulos sólidos não-calcificados 6-8mm

Answer 5

Low risk: Solitary noncalcified solid nodules
measuring 6–8 mm in patients with low
clinical risk are recommended to undergo initial follow-up at 6–12 months depending on size, morphology, and patient preference

Question 6

Tamanho de nódulos em que o uso de PET-CT ou biópsia deve ser considerado

Answer 6

Nódulos sólidos > 8mm

Opacidades de vidro fosco que, durante acompanhamento com TC, desenvolvem opacidade sólida. Aí, considerar ressecção

Nódulos parte-sólidos com componente sólido > 6mm

Question 7

Diferenciação entre nódulos sólidos xx subsólidos

Answer 7

it is generally agreed that nodules that are
rendered partially invisible when viewed
on thin sections with mediastinal (softtissue) window settings and a sharp filter can be regarded as subsolid and that
any nodule components other than normal vascular or bronchial structures that
remain visible on such images are solid

Question 8

Localização mais comum no câncer

Answer 8

Lung cancers occur more frequently in
the upper lobes, with a predilection for
the right lung. Adenocarcinomas and metastases tend to be
located in the periphery, while squamous cancers are more often found near the hila . Small solid nodules
in a perifissural or subpleural location
often represent intrapulmonary lymph
nodes

Question 9

Risco de câncer quando há mais de 5 nódulos?

Answer 9

Baixíssimo. Geralmente são granulomas de infecções passadas.

Question 10

Tempo de duplicação de volume típico de câncer

Answer 10

Volume doubling times for solid
cancers are well established (one volume doubling corresponds to a 26% increase in diameter), with a large majority of times being in the 100–400-day range. For subsolid cancerous nodules,
which represent primary adenocarcinomas, more indolent growth is the rule, with average doubling times on the order of 3–5 years

Question 11

Risco de câncer em pcts com enfisema

Answer 11

Aumenta em 3x

Question 12

Idade e risco de câncer

Answer 12

Lung cancer is still relatively rare in individuals
younger than 35 years and is unusual
before the age of 40 years. For each additional decade of life, lung cancer incidence increases steadily

Question 13

Raça e risco de câncer

Answer 13

Race is also a factor, with a significantly
higher incidence of lung cancer in black
men and native Hawaiian men at low
levels of smoking when compared with
that in white men