Open Access
Subscription Access
Open Access
Subscription Access
Indeterminate Pulmonary Nodule:An Assessment from a Surgeon's Perspective
Subscribe/Renew Journal
Background: Finding of pulmonary nodule in chest X-ray or CT scan during routine investigations or during surveillance for metastasis, in known case of malignancy is not an uncommon occurrence. Even after all routine evaluation, if nature of such a pulmonary nodule cannot be characterized as either benign or malignant then it is termed as Indeterminate Pulmonary Nodule (IPN).
Aim of this study is to put some light on the way to assess such IPN in simplified manner form a surgeon's perspective so that the unnecessary surgery or morbidity and mortality associated with it can be avoided.
Methods: For this article, extensive literature search was performed, using online search engine PubMed, Google, Cochrane database etc. Out of 474 articles, 42 Articles which fulfilled all the eligible criterion, were used for this study.
Results: Most of the studies are in favour of evidence based, step mannered and pragmatic approach to evaluate the IPN. Foremost and most important step in course of evaluation of IPN is proper clinical evaluation and risk assessment in terms of pre-test probability of malignancy. Although morphological characterisation can be done with newer advance imaging techniques but the only way to confirm the malignancy is getting a tissue biopsy.
Conclusions: With proper clinical evaluation, risk assessment analysis and prudent use of advance imaging techniques, a surgeon can prevent the morbidity and mortality associated with unnecessary surgery and other invasive interventions.
Keywords
- Lillington GA. Management of solitary pulmonary nodules. Dis Mon. 1991 May. 37(5):271-318.
- Wahidi MM, Govert JA, Goudar RK, Gould MK, McCrory DC. Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007 Sep. 132(3 Suppl):94S-107S.
- Truong MT, Ko JP, Rossi SE, Rossi I, Viswanathan C, Bruzzi JF, Marom EM, Erasmus JJ. Update in the evaluation of the solitary pulmonary nodule. Radiographics. 2014 Oct;34(6):1658-79. doi: 10.1148/rg.346130092. Review. PubMed PMID: 25310422.
- Midthun DE, Swensen SJ, Jett JR, Hartman TE. Evaluation of nodules detected by screening for lung cancer with low dose spiral computed tomography. Lung Cancer. Aug 2003;41 (suppl 2):S40.
- Silva DR, Baglio PT, Gazzana MB. Nódulo pulmonar solitário. Rev Bras Clin Med. 2009;7:132–9.
- Yankelevitz DF, Henschke CI. Does 2-year stability imply that pulmonary nodules are benign? AJR Am J Roentgenol. 1997;168: 325–8.
- Xu DM, van der Zaag-Loonen HJ, Oudkerk M, Wang Y, Vliegenthart R, Scholten ET, et al. Smooth or attached solid indeterminate nodules detected at baseline CT screening in the NELSON study: cancer risk during 1 year of follow-up. Radiology. 2009 Jan. 250(1):264-72.
- Mosmann MP, Borba MA, Macedo FPN, Liguori AAL, Villarim Neto A, Lima KC. Solitary pulmonary nodule and 18F-FDG PET/CT. Part 1: epidemiology, morphological evaluation and cancer probability. Radiol Bras. 2016 Jan/ Fev; 49(1):35–42
- Xu DM, van Klaveren RJ, de Bock GH, Leusveld AL, Dorrius MD, Zhao Y, et al. Role of baseline nodule density and changes in density and nodule features in the discrimination between benign and malignant solid indeterminate pulmonary nodules. Eur J Radiol. 2009; 70:492–8.
- Ali Nawaz Khan, Hamdan H Al-Jahdali, 1 Klaus L. Irion, 2 Mohammad Arabi, 3 and Shyam Sunder Koteyar. Solitary pulmonary nodule: A diagnostic algorithm in the light of current imaging technique. Avicenna J Med. 2011 Oct-Dec; 1(2): 39–51.
- Schaefer-Prokop C1, Prokop M. New imaging techniques in the treatment guidelines for lung cancer. Eur Respir J Suppl. 2002 Feb; 35:71s-83s.
- Satoh S, Nakaminato S, Kihara A, Isogai S, Kawai S. Evaluation of indeterminate pulmonary nodules with dynamic MR imaging. Magn Reson Med Sci. 2013 Mar 25;12(1):31-8. Epub 2013 Mar 11.
- Michael K. Gould, Jessica Donington ,William R. Lynch, Peter J. Mazzone, David E. Midthun, David P. Naidich and Renda Soylemez Wiener. Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer? DIAGNOSIS AND MANAGEMENT OF LUNG CANCER, 3RD ED: ACCP GUIDELINES. CHEST / 143 / 5 / MAY 2013 SUPPLEMENT
- Behzadi A, Ung Y, Lowe V, Deschamps C. The role of positron emission tomography in the management of non-small cell lung cancer. Can J Surg. 2009 Jun. 52(3):235-42.
- Patel VK, Naik SK, Naidich DP, Travis WD, Weingarten JA, Lazzaro R, Gutterman DD, Wentowski C, Grosu HB, Raoof S. A practical algorithmic approach to the diagnosis and management of solitary pulmonary nodules: part 2: pretest probability and algorithm. Chest. 2013 Mar;143(3):840-6. doi: 10.1378/chest.12-1487. Review.
- Jung EJ, Kim SR, Ryu CG, Paik JH, Yi JG, Hwang DY. Indeterminate pulmonary nodules in colorectal cancer. World J Gastroenterol. 2015 Mar 14;21(10):2967-72. doi: 10.3748/wjg.v21.i10.2967. PubMed PMID: 25780294;
- Nordholm-Carstensen A, Wille-Jørgensen PA, Jorgensen LN, Harling H. Indeterminate pulmonary nodules at colorectal cancer staging: a systematic review of predictive parameters for malignancy. Ann Surg Oncol. 2013 Nov;20(12):4022-30. doi: 10.1245/s10434-013-3062-y. Epub 2013 Jun 28. Review.
- Lee B, Lim A, Lalvani A, Descamps MJ, Leonard R, Nallamala S, Lewis JS, Coombes RC, Stebbing J. The clinical significance of radiologically detected silent pulmonary nodules in early breast cancer. Ann Oncol. 2008 Dec;19(12):2001-6. doi: 10.1093/annonc/mdn421. Epub 2008 Jul 17.
Abstract Views: 166
PDF Views: 0