Solitary pulmonary nodule evaluation of solitary pulmonary nodule
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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 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.
Evaluation of Solitary Pulmonary Nodule
Initial Evaluation Algorithm
Solitary Pulmonary Nodule Detected | |||||||||||||||||||||||||||||||||
Step 1: Assess likelihood of cancer ❑ Mayo Clinic Malignancy Risk Calculator | |||||||||||||||||||||||||||||||||
| Step 2: Review prior films Is there a growth? | No previous films *Refer to step 2A | ||||||||||||||||||||||||||||||||
| Yes, growing | No, stable | ||||||||||||||||||||||||||||||||
Step 2A Enhanced Computed Tomography | Step 2B Surveillance | ||||||||||||||||||||||||||||||||
Imaging evaluation | |||||||||||||||||||||||||||||||||
Location ❑ Upper lobe ❑ Lower lobe ❑ Middle lobe Size ❑ < 8mm ❑ > 8mm Lesion characteristics ❑ Margins (irregular/regular) ❑ Shape (spiculated/rounded) ❑ Attenuation | |||||||||||||||||||||||||||||||||
Other Diagnostic Studies ❑ PET/CT scan | |||||||||||||||||||||||||||||||||
| Low risk ❑ < 5% | Intermediate risk ❑ 5-65% | High risk ❑ > 65% | |||||||||||||||||||||||||||||||
| Serial CT scans | Non-surgical biopsy *Refer to Step 3: Treatment and Follow-up | Surgical resection *Refer to Step 3: Treatment and Follow-up | |||||||||||||||||||||||||||||||
Step 3: Treatment and Follow-up | |||||||||||||||||||||||||||||||||
Malignancy Risk Assessment
The malignancy of pulmonary nodule, can be categorized into 3 groups:
- Low probability
- Intermediate probability
- High probability
Low probability Intermediate probability High probability
The patient risk assessment of pulmonary nodule, can be categorized into 2 groups:
- High risk patients
- Low risk patients