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17 Cards in this Set
- Front
- Back
- 3rd side (hint)
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How do we classify a solitary pulmonary nodule (SPN)? |
Approximately round <3cm diameter (if larger, they're called a mass, and majority would be malignant) |
Shape and size |
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SPNs can be found in how many % of normal population? |
0.1-0.2% |
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What is the main DD of an SPN? |
Bronchogenic carcinoma |
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What is the only definitive diagnostic method for SPNs? |
Biopsy (thoracoscopic) |
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What recommendations have been drawn from the ELCAP study? (lung CA screening study) |
Lesions <1cm: repeat serial CTs Lesions >1cm, FNAB |
Recommendations are for procedures for investigating lesions depending on size |
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What are other DDs for SPNs? |
Neoplastic lesions other than bronchogenic carcinoma (carcinoid, mets) Non-malignant lesions - Infectious granulomas (TB, fungal) - constitute 80% of benign lesions! - Inflammatory lesions (bacterial/organising/eosinophilic pneumonia) - AVM - Hamartomas (10% benign lesions) |
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Which one is now considered a reasonable indicator of a benign lesion? Stability seen on CXR for 2y or Stability seen on CT for 2y |
CT (CXR used to be good but studies have suggested otherwise) |
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Calcification and no spiculation - indicators of benign or malignant likelihood? |
Benign |
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Hamartomas in the lung - how will they show up on radiography? |
Well circumscribed with smooth/lobulated margins. Low density areas suggest fat, high density areas suggest cartilage |
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Why is a contrast enhanced CT good for imaging malignancies? |
Because of increased vascularity in a malignant mass, resulting in increased enhancement. |
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How should we investigate a lesion if it is peripheral? What are the complications? |
FNAB Complications: pneumothorax, bleeding |
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How should we investigate a lesion if it is proximal? |
Bronchoscopy |
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If you suspect a very high risk of malignancy, how does that change your diagnostic strategy? |
Go straight to lobectomy |
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The use of FDG-PET is highly sensitive but less specific (78%). In what cases does it generate false negatives? |
Bronchoalveolar cancer Carcinoid Tumours <1cm |
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In what cases does FDG-PET generate false positives? |
Silicosis Infection Inflammation |
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When is FDG-PET most effective? |
When clinical picture and CT appearance are discordant. |
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Diagnostic strategy for SPN. |
1. Hx, exam 2. Old films 3. CT chest 4. Treatment depends on probability of malignancy - Very high: surgery - High: FNAB - Moderate: FNAB/consider PET - Low: Radiological FU |
We start at hx and physical exam - what do we look at next? What investigation/s? What are our treatment pathways for SNPs with different malignant potentials? |
