Pulmonary Nodule

Question 1

solitary pulmonary nodule is defined as

Answer 1

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

Question 2

>3 cm lesion on imaging is known as a

Answer 2

mass

Question 3

size of nodule

Answer 3

correlates to chances of it being malignant

Question 4

nodules <0.6 cm are less likely

Answer 4

to be malignant don’t need follow up

Question 5

nodules >0.8 cm

Answer 5

need additional management or surveillance

Question 6

factors that increase malignant probability of a solitary pulmonary nodule

Answer 6

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

Question 7

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

Answer 7

biopsy or surgical excision.

Question 8

Surgical excision is

Answer 8

via wedge resection by thoacotomy and video assisted thorascopy VATS

Question 9

bronchoscopy with transbronchial biopsy is helpful for

Answer 9

centrally located nodules.

Question 10

most common cause of benign pulmonary nodules are:

Answer 10

infectious granulomas (TB, histoplasmosis, atypical mycobacteria)

Question 11

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

Answer 11

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

Question 12

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

Answer 12

should have serial CT imaging

Question 13

high risk factors:

Answer 13

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

Question 14

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

Answer 14

no follow up

Question 15

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

Answer 15

CT scan in 6 to 12 months

Question 16

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

Answer 16

no follow up (same as single solid lesion)

Question 17

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

Answer 17

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

Question 18

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

Answer 18

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

Question 19

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

Answer 19

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

Question 20

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

Answer 20

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

Question 21

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

Answer 21

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

Question 22

single solid pulm nodule >8 mm in HIGH risk pt

Answer 22

CT 3 month and consider PET-CT or biopsy

Question 23

single solid pulm nodule >8 mm in LOW risk pt

Answer 23

CT 3 month and consider PET-CT or biopsy

Question 24

multiple solid pulm nodules >8 mm in HIGH risk pt

Answer 24

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

Question 25

multiple solid pulm nodules >8 mm in low risk pt

Answer 25

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

Question 26

subsolid pulmonary nodules on CT can be described as

Answer 26

ground glass on CT or part solid.

Question 27

SINGLE groundglass <6mm pulm nodule

Answer 27

no follow up

Question 28

SINGLE part solid <6mm pulm nodule

Answer 28

no follow up

Question 29

SINGLE ground glass pulm nodule >6mm what to do?

Answer 29

CT 3-6 months and if no change get a q2 year follow up up to 5 years.

Question 30

Single part solid pulm nodule >6mm what to do?

Answer 30

CT 3 to 6 months and if no change, get CT q1year for 5 years.

Question 31

what is the threshold size/criteria to choose to resect a pulmonary nodule?

Answer 31

any change or growth >2 mm need to be evaluated for resection.

Question 32

why don’t we use biopsy for small nodules or use PET-SCAN

Answer 32

too small may miss with biopsy and get false negative with PET scan.

Question 33

how to manage a pulmonary nodule

Answer 33

Question 34

Differential for a solitary pulmonary nodule

Answer 34

Question 35

Assessment of malignancy risk for a solitary pulmonary nodule.

Answer 35

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.

Question 36

summary of pulmonary nodules?

Answer 36