Pulmonary Nodule Flashcards
Define solitary pulmonary nodule
Nodule
% of solitary pulmonary nodules that are malignant
35
Significance of pulmonary nodule
Sub centimeter pulmonary nodules managed differently than nodules > 1 cm
Low risk pt for pulmonary nodule
Age
Pulmonary nodule, higher risk
Former/current smoker
COPD
Environmental / occupational exposures
Hx radiation therapy
Low protest probability, , 4 mm SOLID pulmonary nodule
No F/U needed
Remember this characteristic for fleischner criteria to apply
Must be SOLID nodule
High protest probability, SOLID pulmonary nodule
CT @ 12 Months; if unchanged, no further w/u
Low pretest probability of cancer, SOLID pulmonary nodule 4-6 mm
F/U CT @ 12 mo, if unchanged, no further w/u
*(same as the HIGH pretest probability nodule LESS than 4 mm)
HIGH pretest probability, SOLID pulmonary nodule 4-6 mm
Initial f/u @ 6-12 mo, then @ 18-24 mo if no change
LOW pretest probability of lung CA;
SOLID pulmonary nodule 6-8 mm
Initial f/u CT @ 6-12 mo, then @ 18-24 mo if no change
**(same as for HIGH pretest probability nodule but the smaller range of 4-6 mm)
HIGH pretest probability lung cancer
SOLID pulmonary nodule 6-8 mm
Initial f/u CT @ 3-6 mo
Then @ 9-12 mo;
24 mo
*if no change
LOW pretest probability CA
SOLID pulmonary nodule > 8 mm
F/u CT around 3, 9, & 24 mo.
Dynamic contrast enhanced CT, PET, &/or Bx
HIGH pretest probability cancer
SOLID pulmonary nodule > 8 mm
***same plan as for low pretest probability nodule > 8 mm:
F/u CT around 3, 9, 24 months
Dynamic contrast enhanced CT, PET, &/or Bx
How assess pulmonary nodule 8-30 mm?
Use calculator to predict pretest probability: VA cooperative or mayo clinic module. (low 65%)
*include risk factors: older age, smoking Hx, nodule size, Hx prior CA, upper lobe location, presence of speculation
Low attenuation solitary pulmonary nodule
SUBsolid
*less common, but more likely to be malignant
Low pretest probability SOLID pulmonary nodule 8-30 mm
Surveillance CT @ 3-6 months; 9-12 mo; & 18-24 mo.
Re-Eval for PET imaging, tissue Dx, or excision if evidence of growth
Moderate pretest probability
SOLID pulmonary nodule 8-30 mm
PET/CT
Tissue Diagnosis/Bx if high metabolic uptake
@ least short term surveillance if neg
High pretest probability
SOLID Pulm nodule 8-30 mm
Surgical excision
PET/CT to stage first
Multiple pulmonary nodules found
Eval risk of malignancy for each individual nodule
Surveillance imaging shows stable size of SOLID pulmonary nodule for > 24 mo
Most people stop surveillance imaging
***subsolid/groundglass nodules need longer surveillance… Perhaps lifelong surveillance
Define pulmonary mass
> 30 mm
Need tissue Dx when it is this big. Refer for Bx vs resection
