Quel bilan effectuer pour un nodule pulmonaire ?

Abstract

With the increasing use of computed tomography, pulmonary nodules are very frequently detected. Solid pulmonary nodules must be distinguished from subsolid nodules, as their management will differ. Several guidelines present algorithms for both types of nodules to help physicians to identify pulmonary nodules of malignant cause and to limit iatrogenic consequences of the diagnostic strategy.In solid pulmonary nodules, a pre-test probability of malignancy is defined, using clinical criteria (mainly age, smoking, prior history of cancer) and the characteristics of the nodules at thoracic CT-scan (mainly size, doubling time, calcifications, margins). According to the estimated risk of cancer and to the size of the nodule, follow-up or medical or surgical biopsy of the nodule will be proposed. Follow-up will consist of repeated low-dose non contrast-enhanced thin-section thoracic CT-scans.Subsolid nodules are malignant in about 75 % of cases. They consist of adenocarcinomas in situ, mini-invasive adenocarcinomas or predominantly lepidic adenocarcinomas, which are often diagnosed in younger patients and non-smokers, and which usually, have a slower growth rate. According to the size, if the nodule persists at a thoracic CT-scan performed at 3 months, either follow-up or biopsy can be proposed. In case of follow-up, it should be maintained at least 3 or 5 years, or even longer, according to guidelines.