Spn

Question 1

Sub-centimetric nodule?

Answer 1

<8mm (not detected in PET,CT scan cz must be >1cm )

Question 2

What are the most imp factors to consider in examinening SPN?

Answer 2

Anamnesis(family history of malignant disease)

Age: 5th and 6th decade

Sigara(#1 reason)

Question 3

Why cant you decide whether nodule benign or malignant on chest CT with contrast?

Answer 3

58% specificity

Question 4

Describe the benign SPN?

Answer 4

Popcorn calcification with fatty tissue (presence of focal oil cavity )
and thin cavity wall, grows with the parenchyma of lungs and looks compressed on CT
Diffuse
Central
Lamellar/concentric

Question 5

Describe the malignant SPN? **

Answer 5

Scattered calcification, thick cavity wall and necrotic inside, spikes (corona radiata) and halo sign(ground glass opacity)
-eccentric
-punctuate(scattered,fine calcifications within the tm)
-reticular(net-like structure)
-amorphous(ill-defined calcifications)

Question 6

Describe the speed at which the nodule increases in size?

Answer 6

VDT(volume doubling time)= 20-400 gün ise malign SPN =fast growing=shorter VDT

VDT > 400 gün: yavaş büyüme ve genellikle iyi huylu SPN ile ilişkilidir.=slow growing tumor=longer vdt

VDT < 20 gün: çok hızlı büyüme, genellikle enfeksiyon süreçlerine atfedilebilir.=very fast growing tumor=infection originated

Question 7

Usually clean margins are a sign of benign tumors while only ….. can be malignant?

Answer 7

21%

The rest 79% of malignant tumors are spiky in margins

Question 8

When do we prefer to use CT scan over PA(posteroanterior chest xray)?

Answer 8

When the nodule is smaller than 1cm and
It’s superimposed lesion(overlaps with bone/heart tissue) and borders are not clear

Question 9

Why do we use PET scans?

Answer 9

To see the metabolically active areas of the tumor and superimposed (overlapping) areas

Question 10

If a nodule grew from 2cm to 2.26cm how much did the size grow?

Answer 10

The size doubled from the original size=%26 (0.26cm) equivalent

Question 11

In which lobe is malignant lung cancer most commonly seen?

Answer 11

Upper lobes(right upper)

Question 12

The density of the nodule calcifications is measured by which measurement?

Answer 12

Hounsfield unit(HU);malignant is >164HU (show increased opacity/brightness=hyperdense)
While
benign is <147HU (atypical hyperplasia=GGO=low opacity/brightness=hypodense)

Question 13

What are the most common sub-solid nodules(semi-solid)?

Answer 13

Adenocarcinoma=slowest=low opacity=<147HU=benign

Question 14

what are the advantages of using PET scan?

Answer 14

high specificity

detection of extrapulmonary tumor

ability to stage known lung cancer

detects metabolic activity of tumor, inc metabolic=malignant

Question 15

when do u perform a biopsy. PET/CT, or contrast CT?

Answer 15

when a changing nodule is >8mm after 9-24 months of monitoring

Question 16

when do u only perform CT scan on a nodule?

Answer 16

when the nodule is 4-8 mm in size