Pulmonary Nodule Flashcards

1
Q

solitary pulmonary nodule is defined as

A

rounded opacity <3 cm in average diameter (>3cm is a mass) surrounded by pulmonary parenchyma no regional LAD

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2
Q

>3 cm lesion on imaging is known as a

A

mass

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3
Q

size of nodule

A

correlates to chances of it being malignant

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4
Q

nodules <0.6 cm are less likely

A

to be malignant don’t need follow up

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5
Q

nodules >0.8 cm

A

need additional management or surveillance

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6
Q

factors that increase malignant probability of a solitary pulmonary nodule

A

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

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7
Q

nodules that are >0.8cm that are intermediate or high probability for malignancy (>5% probability) should get

A

biopsy or surgical excision.

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8
Q

Surgical excision is

A

via wedge resection by thoacotomy and video assisted thorascopy VATS

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9
Q

bronchoscopy with transbronchial biopsy is helpful for

A

centrally located nodules.

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10
Q

most common cause of benign pulmonary nodules are:

A

infectious granulomas (TB, histoplasmosis, atypical mycobacteria)

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11
Q

what to do with someone who has a solitary pulmonary nodule that is stable size and appearance over 2 to 3 years

A

no further workup and reassurance as this is low malignancy risk doesn’t matter if lesion is solid.

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12
Q

in absence of previous imaging, those with low risk and intermediate risk between the size of 0.5-0.7 cm

A

should have serial CT imaging

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13
Q

high risk factors:

A

smoking, female, older >35 yrs, family history of lung cancer.

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14
Q

SINGLE solid pulm nodule <6mm in a LOW risk pt

A

no follow up

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15
Q

SINGLE solid pulm nodule <6mm in a HIGH risk pt

A

CT scan in 6 to 12 months

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16
Q

MULTIPLE solid pulm nodules <6mm in a LOW risk pt

A

no follow up (same as single solid lesion)

17
Q

MULTIPLE solid pulm nodules <6mm in a HIGH risk pt

A

CT scan in 6 to 12 months (same as single solid lesion)

18
Q

single solid pulm nodule 6-8 mm in LOW risk pt

A

CT scan in 6-12 months no change in 18-24 months can stop following

19
Q

single solid pulm nodule 6-8 mm in HIGH risk pt

A

CT scan in 6-12 months no change in 18-24 months can stop following

20
Q

multiple solid pulm nodules 6-8 mm in LOW risk pt

A

CT scan in 6-12 months no change in 18-24 months can stop following

21
Q

multiple solid pulm nodules 6-8 mm in HIGH risk pt

A

CT scan in 6-12 months no change in 18-24 months can stop following

22
Q

single solid pulm nodule >8 mm in HIGH risk pt

A

CT 3 month and consider PET-CT or biopsy

23
Q

single solid pulm nodule >8 mm in LOW risk pt

A

CT 3 month and consider PET-CT or biopsy

24
Q

multiple solid pulm nodules >8 mm in HIGH risk pt

A

CT scan in 3-6 months, can stop following if no change in 18-24 months

25
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
26
subsolid pulmonary nodules on CT can be described as
ground glass on CT or part solid.
27
SINGLE groundglass \<6mm pulm nodule
no follow up
28
SINGLE part solid \<6mm pulm nodule
no follow up
29
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.
30
Single part solid pulm nodule \>6mm what to do?
CT 3 to 6 months and if no change, get CT q1year for 5 years.
31
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.
32
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.
33
how to manage a pulmonary nodule
34
Differential for a solitary pulmonary nodule
35
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.
36
summary of pulmonary nodules?