Pulmonary nodules

Question 1

FDG-avidity as measured by SUV differentiating benign vs malignant nodule

Answer 1

Optimal cut-off point that distinguishes benign from malignant lesions is as yet undefined. In most studies that examine diagnostic performance, an SUV >2.5 is typically used to distinguish pulmonary nodules that have a high probability of malignancy.
- Nodules with low SUV less than 2.5 can still be malignant

Question 2

FDG-avidity differentiating moderate, intensely avid

Answer 2

<5 = low intensity
5-10 = moderate
10-15 = intense
>15 = very intense

Question 3

How do you determine baseline avidity in a patient?

Answer 3

Determined by patient’s liver avidity (it has low variability in metabolic activity)

Question 4

subsolid or solid nodules more concerning?

Answer 4

solid

Question 5

SBRT is

Answer 5

stereotactic body RT

Question 6

Unresectable lung cancer types

Answer 6

T4 or N3

Question 7

preferred surgery type for lung cancer

Answer 7

lobectomy with mediastinal lymph node biopsy

Question 8

surgery type not preferred for lung cancer

Answer 8

wedge resection

Question 9

surgical candidacy determined by what metrics?

Answer 9

DLCO + PFTs

Question 10

which intervention has best biopsy yield + downside

Answer 10

CT guided (higher incidence of PTX because of going through pleura, requiring chest tube)

Question 11

yield of thoracentesis for malignancy

Answer 11

60% (really variable depending on tumor type)