Pulmonary Nodule Flashcards
solitary pulmonary nodule is defined as
rounded opacity <3 cm in average diameter (>3cm is a mass) surrounded by pulmonary parenchyma no regional LAD
>3 cm lesion on imaging is known as a
mass
size of nodule
correlates to chances of it being malignant
nodules <0.6 cm are less likely
to be malignant don’t need follow up
nodules >0.8 cm
need additional management or surveillance
factors that increase malignant probability of a solitary pulmonary nodule
large size* (>2 cm independently correlates to a >50% malignant probability)
advanced pt age
female sex
active or previous smoking
family or personal history of lung cancer
upper lobe location
spiculated radiographic appearance
nodules that are >0.8cm that are intermediate or high probability for malignancy (>5% probability) should get
biopsy or surgical excision.
Surgical excision is
via wedge resection by thoacotomy and video assisted thorascopy VATS
bronchoscopy with transbronchial biopsy is helpful for
centrally located nodules.
most common cause of benign pulmonary nodules are:
infectious granulomas (TB, histoplasmosis, atypical mycobacteria)
what to do with someone who has a solitary pulmonary nodule that is stable size and appearance over 2 to 3 years
no further workup and reassurance as this is low malignancy risk doesn’t matter if lesion is solid.
in absence of previous imaging, those with low risk and intermediate risk between the size of 0.5-0.7 cm
should have serial CT imaging
high risk factors:
smoking, female, older >35 yrs, family history of lung cancer.
SINGLE solid pulm nodule <6mm in a LOW risk pt
no follow up
SINGLE solid pulm nodule <6mm in a HIGH risk pt
CT scan in 6 to 12 months
MULTIPLE solid pulm nodules <6mm in a LOW risk pt
no follow up (same as single solid lesion)
MULTIPLE solid pulm nodules <6mm in a HIGH risk pt
CT scan in 6 to 12 months (same as single solid lesion)
single solid pulm nodule 6-8 mm in LOW risk pt
CT scan in 6-12 months no change in 18-24 months can stop following
single solid pulm nodule 6-8 mm in HIGH risk pt
CT scan in 6-12 months no change in 18-24 months can stop following
multiple solid pulm nodules 6-8 mm in LOW risk pt
CT scan in 6-12 months no change in 18-24 months can stop following
multiple solid pulm nodules 6-8 mm in HIGH risk pt
CT scan in 6-12 months no change in 18-24 months can stop following
single solid pulm nodule >8 mm in HIGH risk pt
CT 3 month and consider PET-CT or biopsy
single solid pulm nodule >8 mm in LOW risk pt
CT 3 month and consider PET-CT or biopsy
multiple solid pulm nodules >8 mm in HIGH risk pt
CT scan in 3-6 months, can stop following if no change in 18-24 months
multiple solid pulm nodules >8 mm in low risk pt
CT scan in 3-6 months, can stop following if no change in 18-24 months
subsolid pulmonary nodules on CT can be described as
ground glass on CT or part solid.
SINGLE groundglass <6mm pulm nodule
no follow up
SINGLE part solid <6mm pulm nodule
no follow up
SINGLE ground glass pulm nodule >6mm what to do?
CT 3-6 months and if no change get a q2 year follow up up to 5 years.
Single part solid pulm nodule >6mm what to do?
CT 3 to 6 months and if no change, get CT q1year for 5 years.
what is the threshold size/criteria to choose to resect a pulmonary nodule?
any change or growth >2 mm need to be evaluated for resection.
why don’t we use biopsy for small nodules or use PET-SCAN
too small may miss with biopsy and get false negative with PET scan.
how to manage a pulmonary nodule
Differential for a solitary pulmonary nodule
Assessment of malignancy risk for a solitary pulmonary nodule.
Risk goes up based on size of nodule, age, smoking status, and nodule margin characteristics
Risk for malignancy decreases based on duration of smoking cessation.
summary of pulmonary nodules?
