Pulmonary nodule medical therapy: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
 
(21 intermediate revisions by 2 users not shown)
Line 5: Line 5:
==Overview==
==Overview==


The optimal management approach of solitary pulmonary nodule will mainly depend on the nodule size and growth. Other parameters, such as: location, and distribution may also be helpful for the therapeutical management of solitary pulmonary nodule. Moreover, the solitary pulmonary nodule risk assessment is useful to determine the likelihood for malignancy and prompt treatment.  Surgical resection is often recommended among patients with the malignant likelihood of solitary pulmonary nodule. On the other hand, solitary pulmonary nodules with benign features are eligible for periodic CT surveillance.
The optimal management approach of solitary pulmonary nodule mainly depends on the nodule size and growth. Other parameters, such as location and distribution may also be helpful. [[Surgical resection]] is often recommended among [[Patient|patients]] with a [[malignant]] likelihood of solitary pulmonary nodule. On the other hand, solitary pulmonary nodules with [[benign]] features are eligible for periodic [[Computed tomography|CT]] surveillance.


==Therapeutic Management==
==Medical Therapy==


*The optimal management approach of solitary pulmonary nodule mainly depends on the nodule size and growth.
*Other parameters, such as location and distribution may also be helpful.
*The solitary pulmonary nodule risk assessment is useful to determine the likelihood of [[Cancer|malignancy]] and prompt treatment.
*[[Surgical resection]] is often recommended among [[Patient|patients]] with a [[malignant]] likelihood of solitary pulmonary nodule.
*On the other hand, solitary pulmonary nodules with [[benign]] features are eligible for periodic [[Computed tomography|CT]] surveillance.


===Recommendations for Follow-up and Management of Nodules <8 mm Detected Incidentally at Non-screening CT===
===Management Strategies===


{| border="2" cellpadding="20" cellspacing="0"
The algorithm below summarizes the different management strategies for [[Patient|patients]] with pulmonary nodule:
!Nodule Size (mm)
 
!'''Low risk''' patients
{{familytree/start |summary=PE diagnosis Algorithm.}}
!'''High risk''' patients
{{familytree | A01 |-| A02 |-|-|-| A03 |-|-|-| A04 | | |A01=<div style="width: 10em; padding:1em;">'''Solid solitary pulmonary nodule'''<br> < 8mm</div>|A02=<div style="width: 10em; padding:1em;">'''Solid solitary pulmonary nodule'''<br> > 8mm</div>|A03=<div style="width: 10em; padding:1em;">'''Subsolid/part-solid nodule'''</div>|A04=<div style="width: 10em; padding:1em;">'''Multiple'''</div>}}
{{familytree | |!| | | |!| | | |,|-|^|-|.| | | |!| | | }}
{{familytree | |!| | | |!| | | |!| | | |!| | | |!|}}
{{familytree | B01 | | B02 | | B03 | | B04 | | B05| | |B01='''[[Solitary pulmonary nodule CT|'''Non-enhanced CT scan (NECT)''']]<br><SMALL>*Frequency depends on individual risk assesment</SMALL>|B02=[[Solitary pulmonary nodule evaluation of solitary pulmonary nodule#Malignancy risk assessment|'''Malignancy risk assessment''']]|B03= '''< 5mm'''|B04= '''> 5mm'''|B05='''Each nodule should be assessed individually*'''<br><SMALL>CT surveillance and biopsy accordingly</SMALL> }}
{{familytree | | | | | |!| | | |!| | | |!| | | | | | }}
{{familytree | | | | | C01 | | C02 | | C03 | | | | | | |C01=''' Intermediate Risk'''<br>[[Solitary pulmonary nodule other imaging findings|'''Positron emission tomography''']]<br><SMALL>If positive, request biopsy or surgical excision<br> If negative, serial CT scans* </SMALL> <br>'''High Risk'''<br>[[Solitary pulmonary nodule biopsy|'''Biopsy''']]<br>or<br>[[Solitary pulmonary nodule surgery|'''Surgical excision''']]|C02=[[Solitary pulmonary nodule CT #CT surveillance|'''CT Surveillance''']]<br> Every 3 months|C03='''No additional work-up'''}}
{{familytree/end}}
 
==Follow-Up and Surveillance==
 
*[[Medical guideline|Guideline]] treatment and management recommendations for solitary pulmonary nodule include:
 
:*[[American College of Chest Physicians|American College of Chest Physicians (ACCP)]] [[Medical guideline|guidelines]]
:*Fleischner Society [[Medical guideline|guideline]]
 
*The table below summarizes the follow-up and surveillance recommendations for solitary pulmonary nodule according to the Fleischner Society [[Medical guideline|guideline]]:
 
{|style="border: 5px; font-size: 90%; margin: 5px; width: 1000px" align=center
!style="padding: 5px 5px; background: #4479BA; font-weight: bold; text-align:center;" colspan="3"|{{fontcolor|#FFF|'''Recommendations for Follow-up and Management of Nodules <8 mm <br> Detected Incidentally at Non-screening CT'''}}
|+
!style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Nodule Size (mm)}}
!style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|'''Low risk''' patients}}
!style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|'''High risk''' patients}}
|-
|-
|Less than or equal to 4
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|≤ 4
|No follow-up needed.
|style="padding: 5px 5px; background: #F5F5F5;"|
|Follow-up at 12 months. If no change, no further imaging needed.
* No follow-up needed
|style="padding: 5px 5px; background: #F5F5F5;"|
* Follow-up at 12 months
* If no change, no further [[imaging]] needed
|-
|-
|>4 - 6
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|> 4 - 6
|Follow-up at 12 months. If no change, no further imaging needed.
|style="padding: 5px 5px; background: #F5F5F5;"|
|Initial follow-up CT at 6 -12 months and then at 18 - 24 months if no change.
* Follow-up at 12 months
* If no change, no further [[imaging]] needed
|style="padding: 5px 5px; background: #F5F5F5;"|
* Initial follow-up [[Computed tomography|CT]] at 6 -12 months and then at 18 - 24 months if no change
|-
|-
|>6 - 8
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|> 6 - 8
|Initial follow-up CT at 6 -12 months and then at 18 - 24 months if no change.
|style="padding: 5px 5px; background: #F5F5F5;"|
|Initial follow-up CT at 3 - 6 months and then at 9 -12 and 24 months if no change.
* Initial follow-up [[Computed tomography|CT]] at 6 -12 months and then at 18 - 24 months if no change
|style="padding: 5px 5px; background: #F5F5F5;"|
* Initial follow-up [[Computed tomography|CT]] at 3 - 6 months and then at 9 -12 and 24 months if no change
|-
|-
|>8
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|> 8
|Follow-up CTs at around 3, 9, and 24 months. Dynamic contrast enhanced CT, PET, and/or biopsy
|style="padding: 5px 5px; background: #F5F5F5;"|
|Same at for low risk patients
* Follow-up [[Computed tomography|CT]] at around 3, 9, and 24 months
* Dynamic [[Contrast medium|contrast]] enhanced [[Computed tomography|CT]], [[Positron emission tomography|PET]], and/or [[biopsy]]
|style="padding: 5px 5px; background: #F5F5F5;"|
* Same at for low risk [[Patient|patients]]
|}
|}
 
:<SMALL>Note: Newly detected indeterminate nodule in persons 35 years of age or older.<ref>Heber MacMahon, John H. M. Austin, Gordon Gamsu, Christian J. Herold, James R. Jett, David P. Naidich, Edward F. Patz, Jr, and Stephen J. Swensen. [http://radiology.rsnajnls.org/cgi/content/abstract/237/2/395 Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans: A Statement from the Fleischner Society.] Radiology 2005 237: 395-400.</ref><br>* '''Low risk patients''': Minimal or absent history of [[smoking]] and of other known [[Risk factor|risk factors]]<br>* '''High risk patients''': History of [[smoking]] or of other known [[Risk factor|risk factors]]</SMALL>
Note: Newly detected indeterminate nodule in persons 35 years of age or older.<ref>Heber MacMahon, John H. M. Austin, Gordon Gamsu, Christian J. Herold, James R. Jett, David P. Naidich, Edward F. Patz, Jr, and Stephen J. Swensen. [http://radiology.rsnajnls.org/cgi/content/abstract/237/2/395 Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans: A Statement from the Fleischner Society.] Radiology 2005 237: 395-400.</ref>
 
* '''Low risk patients''': Minimal or absent history of smoking and of other known risk factors.
* '''High risk patients''': History of smoking or of other known risk factors.


==References==
==References==

Latest revision as of 02:58, 2 July 2019

Pulmonary Nodule Microchapters

Home

Patient Information

Overview

Classification

Causes

Differentiating Pulmonary Nodule from Other Diseases

Epidemiology and Demographics

Screening

Natural history, Complications and Prognosis

Diagnosis

Evaluation of Solitary Pulmonary Nodule

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Case Studies

Case #1

Pulmonary nodule medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Pulmonary nodule medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Pulmonary nodule medical therapy

CDC on Pulmonary nodule medical therapy

Pulmonary nodule medical therapy in the news

Blogs on Pulmonary nodule medical therapy

Directions to Hospitals Treating Solitary pulmonary nodule

Risk calculators and risk factors for Pulmonary nodule medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

The optimal management approach of solitary pulmonary nodule mainly depends on the nodule size and growth. Other parameters, such as location and distribution may also be helpful. Surgical resection is often recommended among patients with a malignant likelihood of solitary pulmonary nodule. On the other hand, solitary pulmonary nodules with benign features are eligible for periodic CT surveillance.

Medical Therapy

  • The optimal management approach of solitary pulmonary nodule mainly depends on the nodule size and growth.
  • Other parameters, such as location and distribution may also be helpful.
  • The solitary pulmonary nodule risk assessment is useful to determine the likelihood of malignancy and prompt treatment.
  • Surgical resection is often recommended among patients with a malignant likelihood of solitary pulmonary nodule.
  • On the other hand, solitary pulmonary nodules with benign features are eligible for periodic CT surveillance.

Management Strategies

The algorithm below summarizes the different management strategies for patients with pulmonary nodule:

Solid solitary pulmonary nodule
< 8mm
 
Solid solitary pulmonary nodule
> 8mm
 
 
 
Subsolid/part-solid nodule
 
 
 
Multiple
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-enhanced CT scan (NECT)
*Frequency depends on individual risk assesment
 
Malignancy risk assessment
 
< 5mm
 
> 5mm
 
Each nodule should be assessed individually*
CT surveillance and biopsy accordingly
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Intermediate Risk
Positron emission tomography
If positive, request biopsy or surgical excision
If negative, serial CT scans*
High Risk
Biopsy
or
Surgical excision
 
CT Surveillance
Every 3 months
 
No additional work-up
 
 
 
 
 
 

Follow-Up and Surveillance

  • Guideline treatment and management recommendations for solitary pulmonary nodule include:
  • The table below summarizes the follow-up and surveillance recommendations for solitary pulmonary nodule according to the Fleischner Society guideline:
Recommendations for Follow-up and Management of Nodules <8 mm
Detected Incidentally at Non-screening CT
Nodule Size (mm) Low risk patients High risk patients
≤ 4
  • No follow-up needed
  • Follow-up at 12 months
  • If no change, no further imaging needed
> 4 - 6
  • Follow-up at 12 months
  • If no change, no further imaging needed
  • Initial follow-up CT at 6 -12 months and then at 18 - 24 months if no change
> 6 - 8
  • Initial follow-up CT at 6 -12 months and then at 18 - 24 months if no change
  • Initial follow-up CT at 3 - 6 months and then at 9 -12 and 24 months if no change
> 8
Note: Newly detected indeterminate nodule in persons 35 years of age or older.[1]
* Low risk patients: Minimal or absent history of smoking and of other known risk factors
* High risk patients: History of smoking or of other known risk factors

References

  1. ↑ Heber MacMahon, John H. M. Austin, Gordon Gamsu, Christian J. Herold, James R. Jett, David P. Naidich, Edward F. Patz, Jr, and Stephen J. Swensen. Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans: A Statement from the Fleischner Society. Radiology 2005 237: 395-400.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Pulmonary_nodule_medical_therapy&oldid=1574584"