| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Guest Access | Sign In via User Name/Password
|
|
|
|||||||
Guest Access | Sign In via User Name/Password |
|||||||||
* From the Department of Medicine (Drs. Libby and Smith), Division of Pulmonary and Critical Care Medicine; Department of Surgery (Dr. Altorki), Division of Cardiothoracic Surgery; Department of Medicine (Dr. Pasmantier), Division of Hematology-Oncology; and Department of Radiology (Drs. Yankelevitz and Henschke), Division of Thoracic Radiology, Weill Medical College of Cornell University, New York, NY.
Correspondence to: Daniel M. Libby, MD, FCCP, 407 East Seventieth St, New York, NY 10021
Objectives: To review the Early Lung Cancer Action Project experience and the medical literature from 1993 to 2003 on detection of the small, noncalcified pulmonary nodule by CT in order to formulate a management algorithm for these nodules.
Design: Prospective noncomparative study of smokers without prior malignancy and a review of the medical literature of CT screening of lung cancer.
Interventions: Chest CT and, where appropriate, CT observation for nodule growth, antibiotics, CT-guided fine-needle aspiration (FNA) biopsy, fiberoptic bronchoscopy, and video-assisted thoracoscopic surgery (VATS).
Results: The following factors influence the probability of malignancy in a CT-detected, small, noncalcified pulmonary nodule: size, change in size, age, smoking history, density, number of nodules, gender, circumstance of the CT, spirometry, occupational history, and endemic granulomatous disease. The two diagnostic techniques most useful in evaluating the CT-detected, small, noncalcified nodule are short-term observation of nodule growth by CT and CT-guided FNA. Due to small nodule size and the frequent finding of nonsolid or part-solid nodules, positron emission tomography, fiberoptic bronchoscopy, and VATS were less useful.
Conclusions: Pulmonologists are frequently asked to evaluate the CT-detected, small, noncalcified nodule invisible on standard chest radiography. Immediate biopsy is justified if the likelihood of cancer is high, but if that likelihood is low or intermediate, a period of observation by CT is appropriate. VATS or thoracotomy are rarely necessary for a diagnosis of lung cancer in the CT-detected small pulmonary nodule.
Key Words: CT-detected pulmonary nodule • early lung cancer detection • management
This article has been cited by other articles:
|
|
 |
|
  S. G. Jennings, H. T. Winer-Muram, M. Tann, J. Ying, and I. Dowdeswell Distribution of Stage I Lung Cancer Growth Rates Determined with Serial Volumetric CT Measurements Radiology, November 1, 2006; 241(2): 554 - 563. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Mascalchi, G. Belli, M. Zappa, G. Picozzi, M. Falchini, R. D. Nave, G. Allescia, A. Masi, A. L. Pegna, N. Villari, et al. Risk-benefit analysis of X-ray exposure associated with lung cancer screening in the Italung-CT trial. Am. J. Roentgenol., August 1, 2006; 187(2): 421 - 429. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.-P. Revel, A. Merlin, S. Peyrard, R. Triki, S. Couchon, G. Chatellier, and G. Frija Software volumetric evaluation of doubling times for differentiating benign versus malignant pulmonary nodules. Am. J. Roentgenol., July 1, 2006; 187(1): 135 - 142. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Prosch, G. Strasser, E. Oschatz, E. Schober, B. Schneider, and G. H. Mostbeck Management of patients with small pulmonary nodules: a survey of radiologists, pulmonologists, and thoracic surgeons. Am. J. Roentgenol., July 1, 2006; 187(1): 143 - 148. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. B. Lobrano Partnerships in Oncology and Radiology: The Role of Radiology in the Detection, Staging, and Follow-up of Lung Cancer Oncologist, July 1, 2006; 11(7): 774 - 779. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. B. McCarville, H. M. Lederman, V. M. Santana, N. C. Daw, S. J. Shochat, C.-S. Li, and R. A. Kaufman Distinguishing Benign from Malignant Pulmonary Nodules with Helical Chest CT in Children with Malignant Solid Tumors. Radiology, May 1, 2006; 239(2): 514 - 520. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. K. Ganti and J. L. Mulshine Lung cancer screening. Oncologist, May 1, 2006; 11(5): 481 - 487. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. T. Winer-Muram The solitary pulmonary nodule. Radiology, April 1, 2006; 239(1): 34 - 49. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Khokhar, A Vickers, M S Moore, S Mironov, D E Stover, and M B Feinstein Significance of non-calcified pulmonary nodules in patients with extrapulmonary cancers Thorax, April 1, 2006; 61(4): 331 - 336. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. N. Chhajed, M. Bernasconi, F. Gambazzi, L. Bubendorf, H. Rasch, S. Kneifel, and M. Tamm Combining Bronchoscopy and Positron Emission Tomography for the Diagnosis of the Small Pulmonary Nodule <= 3 cm Chest, November 1, 2005; 128(5): 3558 - 3564. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Mulshine New Developments in Lung Cancer Screening J. Clin. Oncol., May 10, 2005; 23(14): 3198 - 3202. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Parsons, F. C. Detterbeck, and L. A. Parker Accuracy of Helical CT in the Detection of Pulmonary Metastases: Is Intraoperative Palpation Still Necessary? Ann. Thorac. Surg., December 1, 2004; 78(6): 1910 - 1918. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D R Baldwin, J D Birchall, R H Ganatra, and K S Pointon Evaluation of the solitary pulmonary nodule: clinical management, role of CT and nuclear medicine Imaging, October 1, 2004; 16(1): 22 - 36. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
