Pulmonary nodule overview: Difference between revisions

Jump to navigation Jump to search
Line 48: Line 48:


Other diagnostic studies for solitary pulmonary nodule, include: transthoracic percutaneous [[fine needle aspiration]], [[bronchoscopy]], and [[mediastinoscopy]].<ref name="pmid24484269">{{cite journal |vauthors=Kinsey CM, Arenberg DA |title=Endobronchial ultrasound-guided transbronchial needle aspiration for non-small cell lung cancer staging |journal=Am. J. Respir. Crit. Care Med. |volume=189 |issue=6 |pages=640–9 |year=2014 |pmid=24484269 |doi=10.1164/rccm.201311-2007CI |url=}}</ref><ref name="pmid26929459">{{cite journal |vauthors=Mosmann MP, Borba MA, de Macedo FP, Liguori Ade A, Villarim Neto A, de Lima KC |title=Solitary pulmonary nodule and (18)F-FDG PET/CT. Part 1: epidemiology, morphological evaluation and cancer probability |journal=Radiol Bras |volume=49 |issue=1 |pages=35–42 |year=2016 |pmid=26929459 |pmc=4770395 |doi=10.1590/0100-3984.2014.0012 |url=}}</ref>
Other diagnostic studies for solitary pulmonary nodule, include: transthoracic percutaneous [[fine needle aspiration]], [[bronchoscopy]], and [[mediastinoscopy]].<ref name="pmid24484269">{{cite journal |vauthors=Kinsey CM, Arenberg DA |title=Endobronchial ultrasound-guided transbronchial needle aspiration for non-small cell lung cancer staging |journal=Am. J. Respir. Crit. Care Med. |volume=189 |issue=6 |pages=640–9 |year=2014 |pmid=24484269 |doi=10.1164/rccm.201311-2007CI |url=}}</ref><ref name="pmid26929459">{{cite journal |vauthors=Mosmann MP, Borba MA, de Macedo FP, Liguori Ade A, Villarim Neto A, de Lima KC |title=Solitary pulmonary nodule and (18)F-FDG PET/CT. Part 1: epidemiology, morphological evaluation and cancer probability |journal=Radiol Bras |volume=49 |issue=1 |pages=35–42 |year=2016 |pmid=26929459 |pmc=4770395 |doi=10.1590/0100-3984.2014.0012 |url=}}</ref>
===Biopsy===


==Treatment==
==Treatment==

Revision as of 20:24, 17 March 2016

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 overview On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Pulmonary nodule overview

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 overview

CDC on Pulmonary nodule overview

Pulmonary nodule overview in the news

Blogs on Pulmonary nodule overview

Directions to Hospitals Treating Solitary pulmonary nodule

Risk calculators and risk factors for Pulmonary nodule overview

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

Overview

Solitary pulmonary nodule (SPN) is defined as a relatively well defined round or oval pulmonary parenchymal lesion equal or smaller than 30 mm in diameter. Solitary pulmonary nodule is usually surrounded by pulmonary parenchyma and/or visceral pleura an d is not associated with lymphadenopathy, atelectasis, or pneumonia. According to the Fleischner Society, solitary pulmonary nodule may be classified according to size, morphology, and distribution (multiple or single). Causes of solitary pulmonary nodule may be classified into 5 categories: infectious, neoplastic, inflammatory, immunological, vascular, and miscellaneous. Common causes of solitary pulmonary nodule, include: tuberculosis, primary lung cancer, granulomas, and rheumatic disease. In the majority of the cases, solitary pulmonary nodule can be encountered as a incidental finding.[1][2] The nodule most commonly represents a benign tumor, such as a granuloma or hamartoma, but in around 20% of cases it represents a malignant cancer.[2] Approximately 10 to 20% of patients with lung cancer are initially diagnosed with solitary pulmonary nodule.[2] Conventional radiography is the initial method of choice for the diagnosis of solitary pulmonary nodule. The risk assessment of solitary pulmonary nodule will depend on several characteristics, such as: size, growth, shape, margin, air bronchogram sign, and attenuation. The solitary pulmonary nodule risk assessment is useful to determine the likelihood for malignancy and treatment. Further evaluation of solitary pulmonary lung nodule, should include an enhanced CT scan. Other imaging studies, include PET scanning, which may be useful as a staging modality, detection of occult disease, and malignancy assessment. The possibility of cancer needs to be ruled out through further radiological studies and interventions. 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. 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 prognosis of solitary pulmonary nodule depends on the underlying condition.[3]

Classification

According to the Fleischner Society, solitary pulmonary nodules may be classified into 5 categories: solid nodules measuring >8 mm in diameter, solid nodules measuring ≤8 mm in diameter, pure subsolid nodules, part-solid nodules, and multiple nodules.[1]

Causes

Causes of solitary pulmonary nodule may be classified into 5 categories: infectious, neoplastic, inflammatory, immunological, vascular, and miscellaneous. Common causes of solitary pulmonary nodule, include: tuberculosis, primary lung cancer, granulomas, and rheumatic disease.[1]

Differentiating Solitary Pulmonary Nodule from Other Diseases

Solitary pulmonary nodule may be differentiated according to imaging (size, border characteristics, and attenuation), histological, and clinical features, from other diseases that demonstrate similar imaging findings. Common differential diagnosis of solitary pulmonary nodule, include: hamartoma, granulomas, rheumatoid nodule, and single metastasis.[1][4]

Epidemiology and Demographics

Solitary pulmonary nodules are common.[4] The estimated prevalence of incidental solitary pulmonary nodule ranges between 0.09% to 7% in general population.[4] The incidence rate of solitary pulmonary nodule increases with age, tobacco use, and prior cancer; the median age at diagnosis is between 35 to 70 years. The prevalence of malignancy among solitary pulmonary nodules ranges between 0.2% to 50%. Males are more commonly affected with solitary pulmonary nodule than females. The male to female ratio is approximately 2 to 1. There is no racial predilection of solitary pulmonary nodule.[1]

Screening

According to the U.S. Preventive Services Task Force (USPSTF), screening for suspected lung cancer by low-dose computed tomography is recommended every year among smokers who are between 55 to 80 years old and who have history of smoke 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).[5]</nowiki>[6][7]</nowiki>[4][8]

Diagnosis

Evaluation of Solitary Pulmonary Nodule

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.[2]

History and Symptoms

Solitary pulmonary nodules are generally asymptomatic. In some cases, patients may develop non-specific symptoms, such as: dyspnea, hemoptysis, chronic coughing, wheezing, and chest pain. Obtaining the detailed history can be an important aspect of making a diagnosis of solitary pulmonary nodule, specific areas of focus when obtaining the history, include: previous infection of tuberculosis, previous or current smoking history, history of immunological conditions, high occupational risk profession, or recent traveling.[2]

Physical Examination

Patients with solitary pulmonary nodule usually are well-appearing. Physical examination of patients with solitary pulmonary nodule usually has no remarkable findings. In some cases, solitary pulmonary nodule may show findings associated with the underlying condition.[3]

Laboratory Findings

There are no diagnostic laboratory findings associated with solitary pulmonary nodule.[3]

Imaging

Conventional radiography is the initial method of choice for the diagnosis of solitary pulmonary nodule. The evaluation and risk assessment of solitary pulmonary nodule will depend on several characteristics, such as: size, growth, shape, margin, air bronchogram sign, and attenuation. Further evaluation of solitary pulmonary lung nodule, should include enhanced CT scan or MRI imaging. Other imaging studies include PET scanning, which may be useful as a staging modality, detection of occult disease, and malignancy assessment.[3]

Other Diagnostic Studies

Other diagnostic studies for solitary pulmonary nodule, include: transthoracic percutaneous fine needle aspiration, bronchoscopy, and mediastinoscopy.[9][10]


Biopsy

Treatment

Therapeutic Management

The optimal management approach of solitary pulmonary nodule will mainly depend on the nodule size and growth.[2] 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 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.


Prevention

References

  1. 1.0 1.1 1.2 1.3 1.4 Ost D, Fein AM, Feinsilver SH (2003). "Clinical practice. The solitary pulmonary nodule". N. Engl. J. Med. 348 (25): 2535–42. doi:10.1056/NEJMcp012290. PMID 12815140. Unknown parameter |month= ignored (help)
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Alzahouri K, Velten M, Arveux P, Woronoff-Lemsi MC, Jolly D, Guillemin F (2008). "Management of SPN in France. Pathways for definitive diagnosis of solitary pulmonary nodule: a multicentre study in 18 French districts". BMC Cancer. 8: 93. doi:10.1186/1471-2407-8-93. PMC 2373300. PMID 18402653.
  3. 3.0 3.1 3.2 3.3 Lillington GA (1991). "Management of solitary pulmonary nodules". Dis Mon. 37 (5): 271–318. PMID 2019220.
  4. 4.0 4.1 4.2 4.3 McWilliams A, Tammemagi MC, Mayo JR, et. al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med. 2013 Sep 5;369(10):910-9. doi:10.1056/NEJMoa1214726.
  5. Lung Cancer: Screening http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening. Accessed on February 3, 2016 <nowiki>
  6. Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.
  7. National Lung Screening Trial. Wikipedia. https://en.wikipedia.org/wiki/National_Lung_Screening_Trial Accessed on February 4,2016<nowiki>
  8. Recommendations. US preventive services task force(2016) http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=solitary_pulmonary_nodule Accessed on March, 15th 2016
  9. Kinsey CM, Arenberg DA (2014). "Endobronchial ultrasound-guided transbronchial needle aspiration for non-small cell lung cancer staging". Am. J. Respir. Crit. Care Med. 189 (6): 640–9. doi:10.1164/rccm.201311-2007CI. PMID 24484269.
  10. Mosmann MP, Borba MA, de Macedo FP, Liguori Ade A, Villarim Neto A, de Lima KC (2016). "Solitary pulmonary nodule and (18)F-FDG PET/CT. Part 1: epidemiology, morphological evaluation and cancer probability". Radiol Bras. 49 (1): 35–42. doi:10.1590/0100-3984.2014.0012. PMC 4770395. PMID 26929459.


Template:WikiDoc Sources