Chest
Opinions/HypothesesManaging the Small Pulmonary Nodule Discovered by CT
Section snippets
Materials and Methods
We reviewed our experience with lung cancer screening by CT in patients without prior malignancy at the Weill Medical College of Cornell University ELCAP from 1993 to the present, and performed a review of the literature using MEDLINE to evaluate all published studies of CT screening for lung cancer to determine the best approach to the diagnosis and management of the small pulmonary nodule. A small pulmonary nodule was defined as an opacity in the pulmonary parenchyma < 3 cm in greatest
Size
Since CXR studies have shown the likelihood of cancer in solitary pulmonary nodules, it has been recognized that nodule size correlates with the risk of cancer,17 but until CT there were little data on nodules < 1.5 to 2.0 cm in diameter (Table 1).18 It is difficult to recognize lung cancer by CT in nodules < 5 mm in diameter among the many nodules of this size. Lung cancer appears to be rare in nodules < 5 mm in size, and it is safe to repeat the CT at 1 year in these patients (Fig 1, top).78
Discussion
Lung cancer is common and, under present “routine care,” commonly fatal. In CXR screening, less than one third of lung cancers were discovered in stage I. While this represents a great improvement over no screening, it is not sufficient. CT finds lung cancer in stage I 85% of the time, a fact documented in many thousands of patients in the United States, Europe, and Japan.7891011121314
Faced with a small, CT-detected pulmonary nodule, the physician must first assess the likelihood of lung
References (37)
- et al.
The effect of surgical treatment on survival from early lung cancer: implications for screening
Chest
(1992) - et al.
Screening for early lung cancer: results of the Memorial Sloan-Kettering study in New York
Chest
(1984) - et al.
Early Lung Cancer Action Project: overall design and findings from baseline screening
Lancet
(1999) - et al.
Mass screening for lung cancer with mobile spiral computed tomography scanner
Lancet
(1998) - et al.
Evaluation and management of solitary multiple pulmonary nodules
Clin Chest Med
(1993) - et al.
Screening for lung cancer: the Early Lung Cancer Action Project approach
Lung Cancer
(2002) - et al.
CT-guided transthoracic needle biopsy of small solitary pulmonary nodules
Clin Imaging
(1997) - et al.
Nuclear medicine imaging of lung cancer
Radiol Clin North Am
(2000) - et al.
The utility of fiberoptic bronchoscopy in the evaluation of the solitary pulmonary nodule
Chest
(1993) - et al.
The value of transbronchial needle aspiration in the diagnosis of peripheral pulmonary lesions
Chest
(1999)
Recent trends in lung cancer mortality in the United States
J Natl Cancer Inst
Lung cancer screening: the Mayo program
J Occup Med
Survival and mortality from lung cancer in a screened population: the Johns Hopkins study
Chest
Lack of benefit from semi-annual screening for cancer of the lung: follow-up report of a randomized controlled trial on a population of high-risk males in Czechoslovakia
Int J Cancer
Early Lung Cancer Action Project: initial findings on repeat screenings
Cancer
Results of three-year mass screening programme for lung cancer using mobile low-dose spiral computed tomography scanner
Br J Cancer
Screening for lung cancer with low-dose spiral computed tomography
Am J Respir Crit Care Med
Screening for lung cancer with low-dose helical computed tomography: anti-lung cancer association project
J Clin Oncol
Cited by (178)
Comparison of cyanoacrylate and hookwire for localizing small pulmonary nodules: A propensity-matched cohort study
2019, International Journal of SurgeryCitation Excerpt :Due to the widespread use of low-dose CT, small pulmonary nodules (SPNs) were increasingly identified in the screened population, and some suspected to be malignant may require further investigation [2]. Unfortunately, benign-malignant SPN differentiation is sometimes thorny just based on CT or positron emission tomography/CT [3,4]. Video-assisted thoracoscopic surgery (VATS), which allows complete removal of the entire nodule at one setting, provides a minimally invasive method for simultaneously diagnosing and treating SPNs.
Safety and Efficacy of Endovascular Fiducial Marker Insertion for CyberKnife Stereotactic Radiation Therapy Planning in Early-Stage Lung Cancer
2017, Journal of Vascular and Interventional RadiologyPredictive factors of complications during CT-guided transthoracic biopsy
2017, Revue de Pneumologie CliniqueVeterinary diagnostic imaging: Probability, accuracy and impact
2016, Veterinary Journal