Pulmonary Nodules

Question 1

What is the best initial step for Lung lesion?

Answer 1

Compare to prior imaging

Question 2

When do you biopsy the lung lesion?

Answer 2

Enlarging lesions, especially if rapidly enlarging

Question 3

What are common features of a benign nodule?

Answer 3

Age <30
No change in size
nonsmoker
smooth border
small, <1cm
Normal lung
no adenopathy
dense, central calcification
Normal PET scan

Question 4

What are common features of a malignant nodule?

Answer 4

Age >50
Enlarging
Smoker
Spiculated (Spikes)
Large >2cm
Atelectasis
Adenopathy
Sparse, eccentric calcification
abnormal PET scan

Question 5

How do you treat high probability lesions?

Answer 5

Resection of the lesion

Question 6

How do you manage Intermediate probability lesions?

Answer 6

Sputum Cytology: does not r/o malignancy

Bronchoscopy or Transthoracic needle biopsy

PET scan

VATS

Question 7

What is the most appropriate next step for an intermediate probability lesion?

Answer 7

Bronchoscopy or Transthoracic Needle Biopsy
-Central lesions use bronchoscopy
-peripheral lesions use needle biopsy