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 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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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

References