Pulmonary nodule overview: Difference between revisions
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==Overview== | ==Overview== | ||
'''Solitary pulmonary nodule (SPN)''' is defined as a relatively well defined round or oval pulmonary parenchymal lesion equal or smaller than 30 mm in diameter. Solitary pulmonary nodule is usually surrounded by pulmonary parenchyma and/or visceral pleura and is not associated with lymphadenopathy, atelectasis, or pneumonia. According to the Fleischner Society, solitary pulmonary nodule may be classified according to size, morphology, and distribution (multiple/single). Causes of solitary pulmonary nodule may be classified into 5 categories: infectious, neoplastic, inflammatory, immunological, vascular, and miscellaneous. Common causes of solitary pulmonary nodule, include: tuberculosis, primary lung cancer, granulomas, and rheumatic disease. In the majority of the cases, solitary pulmonary nodule can be encountered as a [[incidentaloma|incidental finding]].<ref name="NEJM-cp">{{cite journal |author=Ost D, Fein AM, Feinsilver SH |title=Clinical practice. The solitary pulmonary nodule |journal=N. Engl. J. Med. |volume=348 |issue=25 |pages=2535–42 |year=2003 |month=June |pmid=12815140 |doi=10.1056/NEJMcp012290 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=12815140&promo=ONFLNS19}}</ref><ref name="pmid18402653">{{cite journal |author=Alzahouri K, Velten M, Arveux P, Woronoff-Lemsi MC, Jolly D, Guillemin F |title=Management of SPN in France. Pathways for definitive diagnosis of solitary pulmonary nodule: a multicentre study in 18 French districts |journal=BMC Cancer |volume=8 |issue= |pages=93 |year=2008 |pmid=18402653 |pmc=2373300 |doi=10.1186/1471-2407-8-93 |url=http://www.biomedcentral.com/1471-2407/8/93}}</ref> The nodule most commonly represents a [[benign]] tumor, such as a [[granuloma]] or [[hamartoma]], but in around 20% of cases it represents a [[malignant]] [[cancer]].<ref name="pmid18402653">{{cite journal |author=Alzahouri K, Velten M, Arveux P, Woronoff-Lemsi MC, Jolly D, Guillemin F |title=Management of SPN in France. Pathways for definitive diagnosis of solitary pulmonary nodule: a multicentre study in 18 French districts |journal=BMC Cancer |volume=8 |issue= |pages=93 |year=2008 |pmid=18402653 |pmc=2373300 |doi=10.1186/1471-2407-8-93 |url=http://www.biomedcentral.com/1471-2407/8/93}}</ref> Approximately 10 to 20% of patients with [[lung cancer]] are initially diagnosed with solitary pulmonary nodule.<ref name="pmid18402653"/> The possibility of cancer needs to be ruled out through further radiological studies and interventions. The optimal management approach of solitary pulmonary nodule will mainly depend on the nodule size and growth. Other parameters, such as: location, and distribution may also be helpful for the therapeutical management of solitary pulmonary nodule | '''Solitary pulmonary nodule (SPN)''' is defined as a relatively well defined round or oval pulmonary parenchymal lesion equal or smaller than 30 mm in diameter. Solitary pulmonary nodule is usually surrounded by pulmonary parenchyma and/or visceral pleura and is not associated with lymphadenopathy, atelectasis, or pneumonia. According to the Fleischner Society, solitary pulmonary nodule may be classified according to size, morphology, and distribution (multiple/single). Causes of solitary pulmonary nodule may be classified into 5 categories: infectious, neoplastic, inflammatory, immunological, vascular, and miscellaneous. Common causes of solitary pulmonary nodule, include: tuberculosis, primary lung cancer, granulomas, and rheumatic disease. In the majority of the cases, solitary pulmonary nodule can be encountered as a [[incidentaloma|incidental finding]].<ref name="NEJM-cp">{{cite journal |author=Ost D, Fein AM, Feinsilver SH |title=Clinical practice. The solitary pulmonary nodule |journal=N. Engl. J. Med. |volume=348 |issue=25 |pages=2535–42 |year=2003 |month=June |pmid=12815140 |doi=10.1056/NEJMcp012290 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=12815140&promo=ONFLNS19}}</ref><ref name="pmid18402653">{{cite journal |author=Alzahouri K, Velten M, Arveux P, Woronoff-Lemsi MC, Jolly D, Guillemin F |title=Management of SPN in France. Pathways for definitive diagnosis of solitary pulmonary nodule: a multicentre study in 18 French districts |journal=BMC Cancer |volume=8 |issue= |pages=93 |year=2008 |pmid=18402653 |pmc=2373300 |doi=10.1186/1471-2407-8-93 |url=http://www.biomedcentral.com/1471-2407/8/93}}</ref> The nodule most commonly represents a [[benign]] tumor, such as a [[granuloma]] or [[hamartoma]], but in around 20% of cases it represents a [[malignant]] [[cancer]].<ref name="pmid18402653">{{cite journal |author=Alzahouri K, Velten M, Arveux P, Woronoff-Lemsi MC, Jolly D, Guillemin F |title=Management of SPN in France. Pathways for definitive diagnosis of solitary pulmonary nodule: a multicentre study in 18 French districts |journal=BMC Cancer |volume=8 |issue= |pages=93 |year=2008 |pmid=18402653 |pmc=2373300 |doi=10.1186/1471-2407-8-93 |url=http://www.biomedcentral.com/1471-2407/8/93}}</ref> Approximately 10 to 20% of patients with [[lung cancer]] are initially diagnosed with solitary pulmonary nodule.<ref name="pmid18402653"/> Conventional radiography is the initial method of choice for the diagnosis of solitary pulmonary nodule. The risk assessment of solitary pulmonary nodule will depend on several characteristics, such as: size, growth, shape, margin, air bronchogram sign, and attenuation. The solitary pulmonary nodule risk assessment is useful to determine the likelihood for malignancy and prompt treatment. Further evaluation of solitary pulmonary lung nodule, should include enhanced CT scan or MRI imaging. Other imaging studies include [[PET]] scanning, which may be useful as a staging modality, detection of occult disease, and malignancy assessment. The possibility of cancer needs to be ruled out through further radiological studies and interventions. The optimal management approach of solitary pulmonary nodule will mainly depend on the nodule size and growth. Other parameters, such as: location, and distribution may also be helpful for the therapeutical management of solitary pulmonary nodule. Surgical resection is often recommended among patients with the malignant likelihood of solitary pulmonary nodule. On the other hand, solitary pulmonary nodules with benign features are eligible for periodic CT surveillance. The [[prognosis]] of solitary pulmonary nodule depends on the underlying condition. | ||
==Classification== | ==Classification== | ||
Revision as of 20:57, 15 March 2016
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Pulmonary Nodule Microchapters |
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Treatment |
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Pulmonary nodule overview On the Web |
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American Roentgen Ray Society Images of Pulmonary nodule overview |
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Risk calculators and risk factors for Pulmonary nodule overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
Overview
Solitary pulmonary nodule (SPN) is defined as a relatively well defined round or oval pulmonary parenchymal lesion equal or smaller than 30 mm in diameter. Solitary pulmonary nodule is usually surrounded by pulmonary parenchyma and/or visceral pleura and is not associated with lymphadenopathy, atelectasis, or pneumonia. According to the Fleischner Society, solitary pulmonary nodule may be classified according to size, morphology, and distribution (multiple/single). Causes of solitary pulmonary nodule may be classified into 5 categories: infectious, neoplastic, inflammatory, immunological, vascular, and miscellaneous. Common causes of solitary pulmonary nodule, include: tuberculosis, primary lung cancer, granulomas, and rheumatic disease. In the majority of the cases, solitary pulmonary nodule can be encountered as a incidental finding.[1][2] The nodule most commonly represents a benign tumor, such as a granuloma or hamartoma, but in around 20% of cases it represents a malignant cancer.[2] Approximately 10 to 20% of patients with lung cancer are initially diagnosed with solitary pulmonary nodule.[2] Conventional radiography is the initial method of choice for the diagnosis of solitary pulmonary nodule. The risk assessment of solitary pulmonary nodule will depend on several characteristics, such as: size, growth, shape, margin, air bronchogram sign, and attenuation. The solitary pulmonary nodule risk assessment is useful to determine the likelihood for malignancy and prompt treatment. Further evaluation of solitary pulmonary lung nodule, should include enhanced CT scan or MRI imaging. Other imaging studies include PET scanning, which may be useful as a staging modality, detection of occult disease, and malignancy assessment. The possibility of cancer needs to be ruled out through further radiological studies and interventions. The optimal management approach of solitary pulmonary nodule will mainly depend on the nodule size and growth. Other parameters, such as: location, and distribution may also be helpful for the therapeutical management of solitary pulmonary nodule. Surgical resection is often recommended among patients with the malignant likelihood of solitary pulmonary nodule. On the other hand, solitary pulmonary nodules with benign features are eligible for periodic CT surveillance. The prognosis of solitary pulmonary nodule depends on the underlying condition.
Classification
According to the Fleischner Society, solitary pulmonary nodules may be classified according to size, morphology, and/or distribution (multiple/single).
Causes
Causes of solitary pulmonary nodule may be classified into 5 categories: infectious, neoplastic, inflammatory, immunological, vascular, and miscellaneous. Common causes of solitary pulmonary nodule, include: tuberculosis, primary lung cancer, granulomas, and rheumatic disease.
Differentiating Solitary Pulmonary Nodule from Other Diseases
Solitary pulmonary nodule may be differentiated according to imaging (size, border characteristics, and attenuation), histological, and clinical features, from other diseases that demonstrate similar imaging findings. Common differential diagnosis of solitary pulmonary nodule, include: hamartoma, granulomas, rheumatic nodule, and single metastasis
Epidemiology and Demographics
Solitary pulmonary nodules are common. The prevalence of solitary pulmonary nodule ranges between 8-51%. The incidence rate of solitary pulmonary nodule is approximately 45 per 100 000 individuals in the United States. The incidence of solitary pulmonary nodule increases with age, tobacco use, and prior cancer; the median age at diagnosis is between. Males are more commonly affected with lung masses than females. The male to female ratio is approximately 2 to 1.
Screening
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for solitary pulmonary nodule.[3][4]
Diagnosis
Evaluation of Solitary Pulmonary Nodule
A hallmark feature in the evaluation of solitary pulmonary nodule is the malignancy risk assessment. The evaluation approach of solitary pulmonary nodule will mainly depend in the initial morphological evaluation of the nodule (size, margins, contours, and growth). Other characteristics, such as: location, clinical features, and distribution may be helpful for the risk assessment, therapeutical management, surveillance, and follow-up of solitary pulmonary nodule. Solitary pulmonary nodule can be divided into 4 risk categories: low risk, intermediate, moderate and high risk. Based upon these risk categories, complementary diagnostic studies and management, include: PET/CT scan, CT scan, non-surgical biopsy, and surgical resection.
History and Symptoms
Solitary pulmonary nodules are generally asymptomatic. The majority of patients may develop non-specific symptoms, such as: dyspnea, hemoptysis, chronic coughing, wheezing, and chest pain. Obtaining the detailed history can be an important aspect of making a diagnosis of solitary pulmonary nodule, specific areas of focus when obtaining the history, include: previous infection of tuberculosis, previous or current smoking history, history of immunological conditions, high occupational risk profession, or recent traveling.[5]
Physical Examination
Patients with solitary pulmonary nodule usually are well-appearing. Physical examination of patients with solitary pulmonary nodule usually has no remarkable findings. In some cases, solitary pulmonary nodule may show some findings associated with the underlying condition.
Laboratory Findings
There are no diagnostic laboratory findings associated with solitary pulmonary nodule.
Imaging
Conventional radiography is the initial method of choice for the diagnosis of solitary pulmonary nodule. The evaluation and risk assessment of solitary pulmonary nodule will depend on several characteristics, such as: size, growth, shape, margin, air bronchogram sign, and attenuation. Further evaluation of solitary pulmonary lung nodule, should include enhanced CT scan or MRI imaging. Other imaging studies include PET scanning, which may be useful as a staging modality, detection of occult disease, and malignancy assessment.
Other Diagnostic Studies
Other diagnostic studies for solitary pulmonary nodule, include: transthoracic percutaneous fine needle aspiration, bronchoscopy, and mediastinoscopy[6]
Treatment
Therapeutic Management
The optimal management approach of solitary pulmonary nodule will mainly depend on the nodule size and growth. Other parameters, such as: location, and distribution may also be helpful for the therapeutical management of solitary pulmonary nodule. Moreover, the solitary pulmonary nodule risk assessment is useful to determine the likelihood for malignancy and prompt treatment. Surgical resection is often recommended among patients with the malignant likelihood of solitary pulmonary nodule. On the other hand, solitary pulmonary nodules with benign features are eligible for periodic CT surveillance.
References
- ↑ Ost D, Fein AM, Feinsilver SH (2003). "Clinical practice. The solitary pulmonary nodule". N. Engl. J. Med. 348 (25): 2535–42. doi:10.1056/NEJMcp012290. PMID 12815140. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 2.2 Alzahouri K, Velten M, Arveux P, Woronoff-Lemsi MC, Jolly D, Guillemin F (2008). "Management of SPN in France. Pathways for definitive diagnosis of solitary pulmonary nodule: a multicentre study in 18 French districts". BMC Cancer. 8: 93. doi:10.1186/1471-2407-8-93. PMC 2373300. PMID 18402653.
- ↑ Recommendations. US preventive services task force(2016) http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=solitary_pulmonary_nodule Accessed on March, 15th 2016
- ↑ McWilliams A, Tammemagi MC, Mayo JR, et. al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med. 2013 Sep 5;369(10):910-9. doi:10.1056/NEJMoa1214726.
- ↑ Hakim DN, Pelly T, Kulendran M, Caris JA (2015). "Benign tumours of the bone: A review". J Bone Oncol. 4 (2): 37–41. doi:10.1016/j.jbo.2015.02.001. PMC 4620948. PMID 26579486.
- ↑ Kinsey CM, Arenberg DA (2014). "Endobronchial ultrasound-guided transbronchial needle aspiration for non-small cell lung cancer staging". Am. J. Respir. Crit. Care Med. 189 (6): 640–9. doi:10.1164/rccm.201311-2007CI. PMID 24484269.