Treatment Solitary pulmonary nodule

fdg-pet study of 71-year-old woman solitary pulmonary nodule (thin arrow) in left lower lobe near heart. scan revealed abnormal increased activity @ gastro-esophageal junction (thick arrow). final diagnosis non-hodgkin lymphoma @ both sites.

when solitary pulmonary nodule identified, plans further action made based on likelihood nodule malignant cancer. if risk of malignancy thought low, follow-up imaging (usually serial ct scans) can planned @ later time. if initial impression there high likelihood of cancer, surgical intervention (such video-assisted thoracoscopic surgery) appropriate (provided patient fit surgery). cases in action required situation uncertain, guidelines exist recommend how surveillance there should in defined circumstances. if pulmonary nodule has not grown 2 years , person has no prior history of cancer nodule extremely unlikely malignant. if nodule ground glass longer follow required same applies. more frequent ct scans recommended has not been shown improve outcomes increase radiation exposure , unnecessary health care can expected make patient anxious , uncertain.

if there intermediate risk of malignancy, further imaging positron emission tomography (pet scan) appropriate (if available). around 95% of patients malignant nodule have abnormal pet scan, while around 78% of patients benign nodule normal on pet (this test sensitivity , specificity). thus, abnormal pet scan reliably pick cancer, several other types of nodules (inflammatory or infectious, example) show on pet scan. if nodule has diameter below 1 centimeter, pet scans avoided because there increased risk of falsely normal results. cancerous lesions have high metabolism on pet, demonstrated high uptake of fdg (a radioactive sugar). if lesion found on further imaging suspicious, should surgically excised (via thoracotomy or video-assisted thoracic surgery) confirm diagnosis microscopical examination.

in selected cases, nodules can sampled through airways using bronchoscopy or through chest wall using needle aspiration (which can done under ct guidance). needle aspiration can retrieve groups of cells cytology , not tissue cylinder or biopsy, precluding evaluation of tissue architecture. theoretically, makes diagnosis of benign conditions more difficult, although rates higher 90% have been reported. complications of latter technique include hemorrhage lung , air leak in pleural space between lung , chest wall (pneumothorax). however, not these cases of pneumothorax need treatment chest tube.

other imaging techniques include pet-ct (simultaneous pet scan , ct scan superposition of images), magnetic resonance imaging (mri) or single photon emission computed tomography (spect).