Management Of Solitary Pulmonary Nodules Research Articles

Guideline on Management of Solitary Pulmonary Nodule

The aim of the proposed recommendations is to be a tool to facilitate decision-making in patients with a solitary pulmonary nodule (SPN). For an optimal decision, accessibility to the different diagnostics techniques and patient preferences need to be incorporated.The first assessment, which includes a chest computed tomography scan, separates a group of patients with extrapulmonary neoplasm or a high surgical risk who require individualized management. Another two groups of patients are patients with SPN up to 8mm and those who have a subsolid SPN, for which specific recommendations are established.SPNs larger than 8mm are classified according to their probability of malignancy into low (less than 5%), where observation is recommended, high (higher than 65%), which are managed with a presumptive diagnosis of localized stage carcinoma, and intermediate, where positron emission tomography-computed tomography has high yield for reclassifying them into high or low probability. In cases of intermediate or high probability of malignancy, transbronchial needle aspiration or biopsy of the nodule may be an option.Radiologic observation with low radiation computed tomography without contrast is recommended in SPN with low probability of malignancy, and resection with videothoracoscopy in undiagnosed cases with intermediate or high probability of malignancy.

Decision-tree analysis for cost-effective management of solitary pulmonary nodules in China

Decision-tree analysis for cost-effective management of solitary pulmonary nodules in China

The Role of Nuclear Medicine in The Diagnosis and Management of Solitary Pulmonary Nodules

Solitary pulmonary nodule (SPN) is a frequent finding on the chest x-ray and computed tomography. Nuclear medicine techniques play an important role in the diagnosis and management of SPN. In the current review, we briefly will explain the different nuclear medicine modalities in this regard including positron emission tomography (PET) using 18-F-FDG, and 11-C-Methionine, and single photon emission computerized tomography (SPECT) using somatostatin receptor scintigraphy, 201-Thallium, and 99m-Tc-MIBI.

Diagnosis and management of solitary pulmonary nodules

目前，肺癌已跃居成为我国发病率及死亡率最高的恶性肿瘤，总体5年生存率较低；早诊早治是提高肺癌患者生存率及改善预后的关键，而早期肺癌患者常无任何症状和体征，只在影像学上表现为肺孤立性结节病变。提高对孤立性肺结节良恶性的鉴别诊断能力是临床诊治过程中的难点与热点。随着各种诊治技术的发展，孤立性肺结节病变性质的诊断准确率已大大提高。

Comparison of Quantitatively Analyzed Dynamic Area-Detector CT Using Various Mathematic Methods With FDG PET/CT in Management of Solitary Pulmonary Nodules

The objective of our study was to prospectively compare the capability of dynamic area-detector CT analyzed with different mathematic methods and PET/CT in the management of pulmonary nodules. Fifty-two consecutive patients with 96 pulmonary nodules underwent dynamic area-detector CT, PET/CT, and microbacterial or pathologic examinations. All nodules were classified into the following groups: malignant nodules (n = 57), benign nodules with low biologic activity (n = 15), and benign nodules with high biologic activity (n = 24). On dynamic area-detector CT, the total, pulmonary arterial, and systemic arterial perfusions were calculated using the dual-input maximum slope method; perfusion was calculated using the single-input maximum slope method; and extraction fraction and blood volume (BV) were calculated using the Patlak plot method. All indexes were statistically compared among the three nodule groups. Then, receiver operating characteristic analyses were used to compare the diagnostic capabilities of the maximum standardized uptake value (SUVmax) and each perfusion parameter having a significant difference between malignant and benign nodules. Finally, the diagnostic performances of the indexes were compared by means of the McNemar test. No adverse effects were observed in this study. All indexes except extraction fraction and BV, both of which were calculated using the Patlak plot method, showed significant differences among the three groups (p < 0.05). Areas under the curve of total perfusion calculated using the dual-input method, pulmonary arterial perfusion calculated using the dual-input method, and perfusion calculated using the single-input method were significantly larger than that of SUVmax (p < 0.05). The accuracy of total perfusion (83.3%) was significantly greater than the accuracy of the other indexes: pulmonary arterial perfusion (72.9%, p < 0.05), systemic arterial perfusion calculated using the dual-input method (69.8%, p < 0.05), perfusion (66.7%, p < 0.05), and SUVmax (60.4%, p < 0.05). Dynamic area-detector CT analyzed using the dual-input maximum slope method has better potential for the diagnosis of pulmonary nodules than dynamic area-detector CT analyzed using other methods and than PET/CT.

A Practical Algorithmic Approach to the Diagnosis and Management of Solitary Pulmonary Nodules: Part 1: Radiologic Characteristics and Imaging Modalities

The solitary pulmonary nodule (SPN) is frequently encountered on chest imaging and poses an important diagnostic challenge to clinicians. The differential diagnosis is broad, ranging from benign granulomata and infectious processes to malignancy. Important concepts in the evaluation of SPNs include the definition, morphologic characteristics via appropriate imaging modalities, and the calculation of pretest probability of malignancy. Morphologic differentiation of SPN into solid or subsolid types is important in the choice of follow-up and further management. In this first part of a two-part series, we describe the morphologic characteristics and various imaging modalities available to further characterize SPN. In Part 2, we will describe the determination of pretest probability of malignancy and an algorithmic approach to the diagnosis of SPN.

A Practical Algorithmic Approach to the Diagnosis and Management of Solitary Pulmonary Nodules: Part 2: Pretest Probability and Algorithm

In this second part of a two-part series, we describe an algorithmic approach to the diagnosis of the solitary pulmonary nodule (SPN). An essential aspect of the evaluation of SPN is determining the pretest probability of malignancy, taking into account the significant medical history and social habits of the individual patient, as well as morphologic characteristics of the nodule. Because pretest probability plays an important role in determining the next step in the evaluation, we describe various methods the physician may use to make this determination. Subsequently, we outline a simple yet comprehensive algorithm for diagnosing a SPN, with distinct pathways for the solid and subsolid SPN.

Cost and Outcomes of Patients With Solitary Pulmonary Nodules Managed With PET Scans

No prior study to our knowledge has observed the cost of managing solitary pulmonary nodules of patient groups defined by PET scan results. We combined study and administrative data over 2 years of follow-up. Of 375 individuals with a definitive diagnosis, 54.4% had a malignant nodule and 62.1% had positive PET scan results. Mortality risk was 5.0 times higher (CI, 3.1-8.2) and cost was greater (50,233 dollars vs 22,461 dollars, P<.0001) among patients with malignant nodule. Mortality risk was 4.1 times higher (CI, 2.4-7.0) and cost was greater (47,823 dollars vs 20,744 dollars, P<.0001) among patients with a positive PET scan result. Among patients with a malignant nodule, 4.9% had a false-negative PET scan, but cost and survival were not different from true positives. Among patients with a benign nodule, 22.8% had a false-positive PET scan. These patients had greater cost (33,783 dollars vs 19,115 dollars, P<.01), more surgeries and biopsies, and 3.8 times the mortality risk (CI, 1.6-9.2) of true negatives. Just over one-half (54.5%) of individuals with positive PET scans received surgery. Most individuals with negative PET scans (85.2%) were managed by watchful waiting. They incurred fewer costs than patients with negative PET scans who were managed more aggressively (19,378 dollars vs 28,611 dollars, P<.01). Management of solitary pulmonary nodules is expensive, especially if the nodule is malignant or if the PET scan result is false positive. Among patients with malignant nodules, 2-year survival is poor. Compared with true-positive PET scan results, false-negative results are not associated with lower costs or better outcomes.

Systematic Review of the Cost-effectiveness of PET in Staging of Non–small Cell Lung Cancer and Management of Solitary Pulmonary Nodules

The clinical effectiveness of positron emission tomography (PET) imaging in the assessment and management of lung cancer patients has been documented. However, due to its significant costs, some jurisdictions have been reluctant to implement PET as a standard of care. Our objective was to perform a systematic review of the international literature describing the cost-effectiveness of PET imaging in the staging (ST) of non–small cell lung cancer and the management of solitary pulmonary nodules (SPN).

Video-Assisted Surgery for Lung Cancer. State of the Art and Personal Experience

This paper reviews the role of videothoracoscopy in lung cancer, highlighting its utility in definitive staging, diagnosis, and treatment. We show exploratory videothoracoscopy to be the perfect technique for last-minute staging, looking for tumor invasion, especially parietal T3 and vascular T4 (due to videopericardioscopy), management of solitary pulmonary nodules, and the possibility of radical treatment with video-assisted thoracoscopic lobectomy. We perform an overview of the literature and analyze our experience of 1,381 patients with lung cancer. In 1,277 of them, the final decision on resectability was made by exploratory videothoracoscopy, including 91 by videopericardioscopy (only 30 were considered non-resectable on videopericardioscopy). Solitary pulmonary nodules were diagnosed in 382 cases (190 were cancer), and we performed 260 major lung resections by video-assisted thoracoscopic surgery (22 pneumonectomies, 238 lobectomies/bilobectomies).

Does the availability of positron emission tomography modify diagnostic strategies for solitary pulmonary nodules? An observational study in France

BackgroundPrevious studies showed that at the individual level, positron emission tomography (PET) has some benefits for patients and physicians in terms of cancer management and staging. We aimed to describe the benefits of (PET) in the management of solitary pulmonary nodules (SPNs) in a population level, in terms of the number of diagnostic and invasive tests performed, time to diagnosis and factors determining PET utilization.MethodsIn an observational study, we examined reports of computed tomography (CT) performed and mentioning "spherical lesion", "nodule" or synonymous terms. We found 11,515 reports in a before-PET period, 2002–2003, and 20,075 in an after-PET period, 2004–2005. Patients were followed through their physician, who was responsible for diagnostic management.ResultsWe had complete data for 112 patients (73.7%) with new cases of SPN in the before-PET period and 250 (81.4%) in the after-PET period. Patients did not differ in mean age (64.9 vs. 64.8 years). The before-PET patients underwent a mean of 4 tests as compared with 3 tests for the after-PET patients (p = 0.08). Patients in the before-PET period had to wait 41.4 days, on average, before receiving a diagnosis as compared with 24.0 days, on average, for patients in the after-PET period who did not undergo PET (p < 0.001). In the after-PET period, 11% of patients underwent PET during the diagnostic process. A spiculated nodule was more likely to determine prescription for PET (p < 0.001). Multivariate analysis revealed that patients in both periods underwent fewer tests when PET was prescribed by general practitioners (p < 0.001) and if the nodule was not spiculated (p < 0.001). The proportion of unnecessary invasive approaches prescribed (47% vs. 49%) did not differ between the groups.ConclusionIn our study, 1 year after the availability of PET, the technology was not the first choice for diagnostic management of SPN. Even though we observed a tendency for reduced number of tests and mean time to diagnosis with PET, these phenomena did not fully relate to PET availability in health communities. In addition, the availability of PET in the management of SPN diagnosis did not reduce the overall rate of unnecessary invasive approaches.

A review of the imaging and clinical management of solitary pulmonary nodules

•. A solitary pulmonary nodule is a common occurrence and there may be an overlap between benign and malignant features. •. CT assessment of morphology, density, size, growth rate and enhancement is useful. •. Positron emission tomography imaging is highly sensitive for lesions greater than 7 mm. •. New advances in dynamic MRI, computer aided detection and four-dimensional CT appear promising. The management of solitary pulmonary nodules (SPNs) often causes a clinical dilemma; the clinical challenge is to determine whether lesions are more likely to be benign or malignant. This article examines the imaging characteristics which can help to determine the probability of malignancy or benignity in an SPN, e.g. nodule contour, location, density, cavitation, attenuation, size, enhancement on CT, enhancement on MRI and metabolic characteristics on positron emission tomography. Computerised assessment of nodules is also examined in this article, including both the detection and analysis of morphology.

Diagnosis and management of solitary pulmonary nodules

The advent of computed tomography (CT) screening with or without the help of computer-aided detection systems has increased the detection rate of solitary pulmonary nodules (SPNs), including that of early peripheral lung cancer. Helical dynamic (HD)CT, providing the information on morphologic and hemodynamic characteristics with high specificity and reasonably high accuracy, can be used for the initial assessment of SPNs. 18F-fluorodeoxyglucose PET/CT is more sensitive at detecting malignancy than HDCT. Therefore, PET/CT may be selectively performed to characterize SPNs when HDCT gives an inconclusive diagnosis. Serial volume measurements are currently the most reliable methods for the tissue characterization of subcentimeter nodules. When malignant nodule is highly suspected for subcentimeter nodules, video-assisted thoracoscopic surgery nodule removal after nodule localization using the pulmonary nodule-marker system may be performed for diagnosis and treatment.

Management of SPN in France. Pathways for definitive diagnosis of solitary pulmonary nodule: a multicentre study in 18 French districts

BackgroundThe process of diagnosis and management of solitary pulmonary nodules (SPNs) between 1 and 3 cm is not standardized. This multicentre study investigated how diagnosis of newly discovered SPNs is managed in routine practice.MethodsWe examined 11,515 radiology reports of patients undergoing chest computed tomography (CT) at all 76 radiology centres in 18 French administrative districts covering 8,220,000 people. Information on diagnostic procedures and treatment administered from discovery to definitive diagnosis of SPN was collected prospectively.ResultsWe identified 152 cases of newly diagnosed SPNs. Follow-up was complete for 112 patients. The median number of diagnostic tests was 4 and the mean time to diagnosis was 41.4 days. Marked variability was observed in the sequence of diagnostic tests, and 8 diagnostic pathways were identified. Patients' characteristics and radiological features of SPNs influenced the number of tests performed. Referral by specialist, history of smoking and spiculated SPN predicted the performance of at least one invasive procedure (P < 0.01). Definitive diagnosis was a malignant disease in 30 patients (26%).ConclusionThe diagnosis of SPN is a complex process that physicians approach in markedly different ways. Implementing practice guidelines for managing the diagnosis of SPN requires clarification.

Management of solitary pulmonary nodule

The pulmonary nodule is an important diagnostic and therapeutic problem. Diagnostic certainty is only obtained by histological examination. Mini-invasive surgery allows removal of the nodule with minimal sequelae for the patient. From October 1991 to December 2006, 370 resections for a pulmonary nodule were performed at our Department of General Surgery of the University of Milan: 276 wedge resections and 94 lobectomies. Frozen section was performed in all the wedge resections, and in the presence of cancer (77 cases), whenever possible (61 cases), the intervention was converted to lobectomy in the same session. In the other 94 cases, the nodule was removed by lobectomy due to the impossibility of performing a wedge resection. Despite the refinement of diagnostic techniques, only exeresis of a pulmonary nodule ensures a definitive diagnosis, thus resolving the problem of benign pathologies and initiating the correct therapy for malignant lesions in the same session.

Diagnosis and management of solitary pulmonary nodule

随着CT等技术的广泛应用,孤立性肺结节的发现越来越多.由于难以鉴别良恶性,给临床治疗带来了很大的困难.正确诊断与处理孤立性肺结节关系到治疗的正确与否,并与生存质量及预后密切相关.良性与恶性孤立性肺结节的生长周期、放射学表现有一定的区别,通过CT、正电子发射计算机断层扫描(PET)、支气管镜检查、经皮细针穿刺活检等手段可以明确诊断,指导正确治疗。

Large Field Trial for Lung Cancer Screening: Putting the Wrong Cart before the Horse?—Commentary

HomeRadiologyVol. 243, No. 2 PreviousNext Reviews and CommentaryEditorialsLarge Field Trial for Lung Cancer Screening: Putting the Wrong Cart before the Horse?—CommentaryDavid GurDavid GurAuthor Affiliations1From the Department of Radiology, University of Pittsburgh, Imaging Research, Suite 4200, 300 Halket St, Pittsburgh, PA 15213. Received July 19, 2006; final version accepted July 24. Address correspondence to the author (e-mail: [email protected]).David GurPublished Online:May 1 2007https://doi.org/10.1148/radiol.2431061252MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References1 Black WC, Aberle DR, Berg CD. Large field trial for lung cancer screening: putting the wrong cart before the horse? Radiology 2007; 243(1): 314–316. Link, Google Scholar2 Gur D. Lung cancer screening: radiology's opportunity here and now. Radiology 2006; 238(2): 395–397. Link, Google Scholar3 Pisano ED, Gatsonis CA, Yaffe MJ, et al. American College of Radiology Imaging Network digital mammographic imaging screening trial: objectives and methodology. Radiology 2005; 236(2): 404–412. Link, Google Scholar4 Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke: results of an international randomized trial. The EC/IC Bypass Study Group. N Engl J Med 1985; 313(19): 1191–1200. Crossref, Medline, Google Scholar5 Planning for progress: office of science planning and assessment (OSPA)—report of the Lung Cancer Progress Review Group. National Cancer Institute Web site. http://planning.cancer.gov/pdfprgreports/2001lung.pdf. Accessed July 7, 2006. Google ScholarArticle HistoryPublished in print: 2007 FiguresReferencesRelatedDetailsRecommended Articles Low-Dose CT Screening for Lung Cancer: Evidence from 2 Decades of StudyRadiology: Imaging Cancer2020Volume: 2Issue: 2Barriers to Lung Cancer Screening Engagement from the Patient and Provider PerspectiveRadiology2019Volume: 290Issue: 2pp. 278-287Mediastinal Lymphadenopathy in the National Lung Screening Trial (NLST) Is Associated with Interval Lung CancerRadiology2021Volume: 302Issue: 3pp. 684-692The Vancouver Lung Cancer Risk Prediction Model: Assessment by Using a Subset of the National Lung Screening Trial CohortRadiology2016Volume: 283Issue: 1pp. 264-272Radiologic Features of Small Pulmonary Nodules and Lung Cancer Risk in the National Lung Screening Trial: A Nested Case-Control StudyRadiology2017Volume: 286Issue: 1pp. 298-306See More RSNA Education Exhibits Management of Solitary Pulmonary Nodules: Pushing the Limits Beyond the GuidelinesDigital Posters2019Shared Decision Making: A Primer for the Busy RadiologistDigital Posters2018Introduction to Artificial Intelligence and Big Data Research in Chest RadiologyDigital Posters2019 RSNA Case Collection Diffuse idiopathic pulmonary neuroendocrine cell hyperplasiaRSNA Case Collection2020Lung Carcinoma Metastatic to the BreastRSNA Case Collection2020Locally Advanced Breast CancerRSNA Case Collection2021 Vol. 243, No. 2 Metrics Altmetric Score PDF download

The role of surgery in the management of solitary pulmonary nodule in breast cancer patients

Aims To assess the role of surgery in the diagnosis and treatment of a solitary pulmonary nodule (SPN) in patients who had received previous surgery for breast cancer. Methods A series of 79 consecutive patients who underwent surgery for an SPN between 1990 and 2003 after a curative resection for breast cancer were reviewed. Results Surgical diagnosis was obtained by open procedure before 1996 (37 cases), and by video-assisted thoracoscopic surgery (VATS) after 1996 (33 out of 42 cases, 9 open procedures) and intraoperative evaluation. Histology of SPN was primary lung cancer in 38 patients, pulmonary metastasis of breast cancer in 27, and benign condition in 14. VATS was converted to open procedure for anatomical resection in primary lung cancer and for the palpation of the lung in metastatic disease. Average disease-free interval from the initial mastectomy was significantly longer in primary lung cancer than in metastatic patients (179 ± 107 vs 51 ± 27 moths). Manual palpation identified multiple pulmonary nodules in 3 out of 27 metastatic patients. Five-year survival rate after pulmonary metastasectomy was 38% and was significantly influenced by disease-free interval; 5-year survival rate after resection of primary lung cancer was 43% and was significantly influenced by the pathological stage. Conclusions VATS is a good procedure for diagnostic management of peripheral SPN. As SPN in breast cancer patients is primary lung cancer in half cases, it deserves confirmation of pathological diagnosis and appropriate surgical treatment. When breast cancer metastasis is demonstrated, open procedure must be performed to palpate the entire lung to exclude previously unknown nodules.

Integrated multislice CT and Tc–99m Sestamibi SPECT–CT evaluation of solitary pulmonary nodules

The purpose of this study was to evaluate efficacy of multislice computed tomography (MSCT) and single photon emission computed tomography (SPECT)-CT with Tc-99m Sestamibi in the assessment of solitary pulmonary nodules of uncertain significance. Scintigraphy was performed using a 'hybrid' g-camera that allows simultaneous acquisition of SPECT and CT images, with interesting results in diagnostic oncology. Between September 2003 and August 2004, 23 patients with a solitary pulmonary nodule detected on CT underwent SPECT-CT using Tc-99m Sestamibi as a radiotracer. Nodules with positive scintigraphy were immediately subjected to biopsy or surgical resection. Nodules with negative scintigraphy were followed up after 3-4 months by MSCT with automatic segmentation software (Advanced Lung Analysis, ALA) and histological characterisation. Of the 23 nodules (size range 0.8-2 cm) discovered with MSCT, 11 showed intense uptake of Tc-99m Sestamibi. Ten lesions were true positive: seven adenocarcinomas, one squamous cell carcinoma, one large cell carcinoma and one metastasis. The only false positive was histologically classified as a large cell granuloma. Twelve lesions had negative scintigraphy: five fibrous lesions, three hamartomas, three granulomas and one adenocarcinoma (false negative). Benign nodules without tracer uptake underwent another CT scan 3-4 months later, which confirmed stability of the nodule size. Correlation of Sestamibi SPECT with histology showed sensitivity (Se) of 90.9 %, specificity (Sp) of 91.6 %, diagnostic accuracy of 91.3 %, positive predictive value (PPV) of 90.9% and negative predictive value (NPV) of 91.6 %. The integrated use of MSCT and Tc-99m Sestamibi SPECT-CT could be very useful in the management of solitary pulmonary nodules (SPNs). In particular, in our preliminary study, scintigraphy provided significant diagnostic information to differentiate benign from suspicious pulmonary nodules. The use of scintigraphy could be helpful to anticipate histological assessment and surgical treatment of SPNs identified at CT.

Hamartochondrome pulmonaire : une cause rare de nodule pulmonaire solitaire en pédiatrie

Pulmonary hamartochondroma: a rare cause of solitary pulmonary nodule in children J Radiol 2005;86:79-82. Solitary pulmonary nodules are rare in children. We report an eleven year-old girl evaluated for recurrent respiratory symptoms diagnosed with an intraparenchymal pulmonary hamartochondroma. Spiral computed tomography showed a pulmonary nodute in the middle lobe, 17 mm in diameter, without any specifie features. In asymptomatic adult patients, guidelines for the management of solitary pulmonary nodules have been described. The management of solitary pulmonary nodules in pediatrie patients is discussed.