Solitary Pulmonary Nodule Flashcards
a single, well-circumscribed, rounded dense pulmonary lesion, 3cm or less in diameter completely surrounded by pulmonary parenchyma without evidence of adenopathy or atelectasis
Small pulmonary nodule
6 independent predictors of malignancy?
- history of smoking
- older age
- history of an extrathoracic cancer at least 5 years prior to nodule detection
- larger nodule diameter ( > 1cm is suspicious)
- upper lobe location
- the presence of spiculation
- typically the periphery of lung
- less associated with pulmonary symptoms
- grow slowly, invade lymphatics & vessels sooner, increase mets
- brionchioalveolar is subtype
- women > men
adenocarcinoma
- 25-30% in central-lung near bronchus
- slow growing spreading along bronchial wall and tend to become cavitary
- sxs- cough, hemptysis, etc
- peripheral SCC often invade the chest wall
- Men > women
Squamous cell cancer
signs and symptoms of lung cancer
- cough
- weight loss
- hemoptysis
- pleuritic CP
- dsypnea
- bone pain
- pleural effusion
- clubbing
- superior vena cava syndrom
- undifferentiated with rapid growth and spread
- bulky tumors often in the periphery
- associated with necrosis, but no cavitation
- difficult to treat
Large cell
- start near the bronchus and spread widely & rapidly
- most common cause of superior vena cava syndrome
- also Pancoast tumor symptoms and paraneoplastic syndromes
- surgery is rarely the only answer, longer survival if wedged out prior to oncology treatment
- needs chemo/rads
Small cell lung cancer
- slow growing (serial CTs typically > 24 months)
- smooth, round, lobulated nodules
- minimal activity on PET scan, 25% false negatives
- surgical wedge resection of lobectomy if centrally located
carcinoid of the lung
Diagnosis of SPNs?
- 60-80% of resected pulmonary nodules are malignant
- survival is 80% at 5 years for resected malignant nodules if caught early
- infectous granulomas cause approx. 80%
- only tissue biopsy can definitively diagnose nodule
recommendation for SPN for low-risk primary
- < 4mm: no follow up
- 5-6mm: F/U chest CT in 12 months, if no change, no further follow up
- 6-8mm: F/U chest CT in 6 to 12 months and then at 18-24 months if no change
- > 8 mm: follow up at 3, 9, and 24 months or dynamic chest, CT, PET and/or biopsy
Low risk: no history of smoking or other factors
Recommendation for SPN with high risk primary
- < 4mm: F/U chest CT in 12 months, no change = no further follow up
- 5-6mm: Follow up chest CT in 6 to 12 months, and then at 18-24 months if no change
- 6-8mm: F/u chest CT in 3 to 6 months, and then at 9-12 months and 24 months if no change
- > 8mm: follow up at 3, 9 and 24 months or dynamic chest CT, PET and/or biopsy
High risk: history of smoking and/or other malignancy
- usually the result of an inflammatory response to a previous granulomatous infection, tuberculosis or atypical mycobacteria
- the most common presentation of this SPN is a harmartoma
- other causes: RA, fibrosing alveolitis, bronchogenic cysts or hemangiomas
Benign SPN
- most common benign neoplasm
- 10% of all primary tumors
- men > women, 6th decade
- CXR: solitary, smooth, lobulated, “popcorn” calcified, slow growing
- CT- calcification with central fat
- tissue biopsy needed to exlude malignancy, very hard to diagnose with FNA
Harmartoma
Important considerations to consider about size when looking at SPN on CT
- Size (directly propertional to the probablility of malignancy)
Important considerations to consider about morphology when looking at SPN on CT
Spiculated (5x more likely malignant)
- possible organizing or resolving pneumonia
Smooth (5x less likely malignant)
- Possible solitary met or carcinoid
Lobulated (benign or malignant)
- harmartoma, peripheral carcinoid, adeno ca
Calcified
- central or diffuse- benign, other patterns could represent malignancy
Popcorn like
- Harmartoma, if associated with intranodular fat
