Lung mass evaluation

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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 lung mass is the malignancy assessment. The evaluation approach of lung mass will mainly depend on the initial morphological evaluation of the mass (size, margins, contours, calcification pattern, and growth). Other characteristics, such as location, clinical features, and distribution, may be helpful for the therapeutic management, surveillance, and follow-up of lung mass. Lung mass can be divided into 2 categories: benign pulmonary mass and malignant lung mass. Based upon these categories, complementary diagnostic studies and management, include: PET/CT scan, CT scan, non-surgical biopsy, and surgical resection.

Lung Mass Evaluation

  • The algorithm below summarizes the initial lung mass evaluation according to imaging features.
 
 
 
 
 
 
Lung Mass Detected
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Step 1: Assess likelihood of cancer
❑ Request enhanced CT scan
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Step 2: What are the imaging features?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hyperdense pulmonary mass
❑ Internal calcification
 
 
 
 
 
 
Cavitating pulmonary mass
❑ Gas-filled area
❑ Thick wall (must be greater than 2-5 mm)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Other diagnostic studies
❑ Sputum cytology
❑ Endobronchial ultrasound
❑ Endoscopic ultrasound
❑ Bronchoscopy
❑ Mediastinoscopy
❑ PET/CT
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Biopsy
 
 
 
 
 
 



 
 
 
 
 
 
 
 
 
 
Lung opacity on Chest X ray (CXR)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Size >3 cms; classified as lung mass
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Size <3 cms; classified as pulmonary nodule
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
High resolution chest CT scan
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Check previous CXR
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Imaging features
 
 
 
 
 
 
 
 
 
 
 
 
Previous CXR normal; suggesting new growth
 
 
 
Previous CXR shows opacity but stable in size since then
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hyperdense pulmonary mass
❑Internal/eccentric calcification
 
 
 
Cavitating pulmonary mass
❑ Gas-filled area
❑ Thick/spiculated wall (must be greater than 2-5 mm)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Follow up every 2-3 yrs
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Other diagnostic studies
❑ Sputum cytology

❑ Endobronchial ultrasound
❑ Endoscopic ultrasound
❑ Bronchoscopy
❑ Mediastinoscopy
 
 
 
 
 
 
 
 
 
 
 
 
High resolution chest CT scan
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Highly suspicious for malignancy
•Age >60yrs
•Current smoker
•Size >2cms
 
 
 
Suspicious for malignancy
•Age 40-60yrs
•Current smoker
•Size 0.8-2cms
 
 
 
 
Benign features
•Age <40yrs
•Non smoker
•Size <0.8cm
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PET or biopsy
 
 
 
 
Serial CT scans
 
 
 
 
 
PET with biopsy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Malignancy
 
No evidence of malignancy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Surgical excision/Chemo depending upon histopathology
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No growth over time
 
 
Lesion grows over time
 
 
 
 
 
 
 
 
 
 
 
 
 
Surgical excision/Chemo depending upon histopathology
 
Serial CT scans
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No further workup
 
 
PET with or biopsy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Surgical excision/Chemo depending upon histopathology


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