Solitary pulmonary nodule evaluation of solitary pulmonary nodule

A hallmark feature in the evaluation of pulmonary nodule is the malignancy risk assessment. The evaluation approach for 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 in the risk assessment, management, surveillance, and follow-up of pulmonary nodule. Pulmonary nodule can be divided into 3 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.

The malignancy risk assessment for pulmonary nodule considers the following factors:^[1]

• Age
• Smoking

• Current
• Never smoker

• Cancer

• Extrathoracic cancer more than 5 years prior

• Nodule diameter
• Spiculation

• Yes
• No

• Upper lobe

• Yes
• No

• The risk calculator is not validated for patients with history of cancer in the past 5 years.^[1]

The malignancy of pulmonary nodule can be categorized into 3 groups:^[2]

Low Probability

• Usually less than < 5 percent
• The nodule size is less than or equal to 4 mm
• The nodule size may also be between 4 – 6 mm, with no associated risk factors
• Observation is suggested
• Observation usually involves radiologic surveillance with serial CT scans

Intermediate Probability

• Between 5 to 65 percent
• The nodule size is between 6 – 8 mm
• The nodule size is more than > 8 mm with associated risk factors
• Diagnostic testing is indicated: Positron emission tomography (PET), CT–FNA, and bronchoscopy

High Probability

• More than > 65 percent
• The nodule size is more than > 8 mm with associated risk factors
• Diagnostic testing is indicated: Positron emission tomography (PET), CT–FNA, and bronchoscopy
• Surgical excision

The patient risk assessment of pulmonary nodule can be categorized into 2 groups:^[2]

• High Risk Patients

• Patient age is > 35
• Positive smoking history
• Male patients
• Positive for prior malignancy
• Other associated risk factors.

• Low Risk Patients

• Patient age < 35
• No smoking history
• Female patients
• Negative for prior malignancy
• No associated risk factors