Lung mass evaluation
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Lung Mass Microchapters |
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Diagnosis |
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Treatment |
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Lung mass evaluation On the Web |
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American Roentgen Ray Society Images of Lung mass evaluation |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
Overview
A hallmark feature in the evaluation of lung mass is the malignancy assessment. The evaluation approach of lung mass will mainly depend on the initial morphological evaluation of the mass (size, margins, contours, calcification pattern, and growth). Other characteristics, such as location, clinical features, and distribution, may be helpful for the therapeutic management, surveillance, and follow-up of lung mass. Lung mass can be divided into 2 categories: benign pulmonary mass and malignant lung mass. Based upon these categories, complementary diagnostic studies and management, include: PET/CT scan, CT scan, non-surgical biopsy, and surgical resection.
Lung Mass Evaluation
- The algorithm below summarizes the initial lung mass evaluation according to imaging features.
Lung Mass Detected | |||||||||||||||||||||||||||||||
Step 1: Assess likelihood of cancer ❑ Request enhanced CT scan | |||||||||||||||||||||||||||||||
| Step 2: What are the imaging features? | |||||||||||||||||||||||||||||||
| Hyperdense pulmonary mass ❑ Internal calcification | Cavitating pulmonary mass ❑ Gas-filled area ❑ Thick wall (must be greater than 2-5 mm) | ||||||||||||||||||||||||||||||
| Other diagnostic studies ❑ Sputum cytology ❑ Endobronchial ultrasound ❑ Endoscopic ultrasound ❑ Bronchoscopy ❑ Mediastinoscopy ❑ PET/CT | |||||||||||||||||||||||||||||||
| Biopsy | |||||||||||||||||||||||||||||||
| Lung opacity on Chest X ray (CXR) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Size >3 cms; classified as lung mass | Size <3 cms; classified as pulmonary nodule | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| High resolution chest CT scan | Check previous CXR | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Imaging features | Previous CXR normal; suggesting new growth | Previous CXR shows opacity but stable in size since then | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hyperdense pulmonary mass ❑Internal/eccentric calcification | Cavitating pulmonary mass ❑ Gas-filled area ❑ Thick/spiculated wall (must be greater than 2-5 mm) | Follow up every 2-3 yrs | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Other diagnostic studies ❑ Sputum cytology ❑ Endobronchial ultrasound ❑ Endoscopic ultrasound ❑ Bronchoscopy ❑ Mediastinoscopy | High resolution chest CT scan | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Highly suspicious for malignancy •Age >60yrs •Current smoker •Size >2cms | Suspicious for malignancy •Age 40-60yrs •Current smoker •Size 0.8-2cms | Benign features •Age <40yrs •Non smoker •Size <0.8cm | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| PET or biopsy | Serial CT scans | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| PET with biopsy | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Malignancy | No evidence of malignancy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Surgical excision/Chemo depending upon histopathology | No growth over time | Lesion grows over time | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Surgical excision/Chemo depending upon histopathology | Serial CT scans | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No further workup | PET with or biopsy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Surgical excision/Chemo depending upon histopathology | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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