open access

Vol 85, No 6 (2017)
REVIEWS
Published online: 2017-12-14
Submitted: 2017-09-07
Accepted: 2017-10-30
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Solitary pulmonary nodule — the role of imaging in the diagnostic process

Marcin Paśnik, Iwona Bestry, Kazimierz Roszkowski - Śliż
DOI: 10.5603/ARM.2017.0059
·
Pubmed: 29288485
·
Adv Respir Med 2017;85(6):345-351.

open access

Vol 85, No 6 (2017)
REVIEWS
Published online: 2017-12-14
Submitted: 2017-09-07
Accepted: 2017-10-30

Abstract

A solitary pulmonary nodule is a round opacity less than 30 mm in diameter surrounded by normally aerated lung tissue. Determination of the character of the lesion following its detection (particularly when the identification was incidental) may require a complex diagnostic process. In most cases, nodules are benign in character; however, the probability of malignancy increases significantly for part-solid lesions. The main features that describe the solitary pulmonary nodule in computed tomography scans include their size, shape, density, presence of calcification and rate of growth. PET-CT examination provides additional information on the metabolic activity of the lesions, and MRI is helpful in assessment of local invasion of surrounding structures. Due to limited availability and highly specialized character, these examinations are not routinely used. Therefore, despite development of other imaging modalities, computed tomography remains the most important and crucial diagnostic tool. Clinical risk factors such as age or smoking status are very important for evaluation of the likelihood of malignancy of a nodular lesion. Due to the multidisciplinary nature of data required for complex assessment of a solitary nodular lesion, management routines are needed in the diagnostic process such as those proposed by the Fleischner Society.

Abstract

A solitary pulmonary nodule is a round opacity less than 30 mm in diameter surrounded by normally aerated lung tissue. Determination of the character of the lesion following its detection (particularly when the identification was incidental) may require a complex diagnostic process. In most cases, nodules are benign in character; however, the probability of malignancy increases significantly for part-solid lesions. The main features that describe the solitary pulmonary nodule in computed tomography scans include their size, shape, density, presence of calcification and rate of growth. PET-CT examination provides additional information on the metabolic activity of the lesions, and MRI is helpful in assessment of local invasion of surrounding structures. Due to limited availability and highly specialized character, these examinations are not routinely used. Therefore, despite development of other imaging modalities, computed tomography remains the most important and crucial diagnostic tool. Clinical risk factors such as age or smoking status are very important for evaluation of the likelihood of malignancy of a nodular lesion. Due to the multidisciplinary nature of data required for complex assessment of a solitary nodular lesion, management routines are needed in the diagnostic process such as those proposed by the Fleischner Society.
Get Citation

Keywords

solitary pulmonary nodule; non-solid nodule; management strategy; chest imaging; lung neoplasms

About this article
Title

Solitary pulmonary nodule — the role of imaging in the diagnostic process

Journal

Advances in Respiratory Medicine

Issue

Vol 85, No 6 (2017)

Pages

345-351

Published online

2017-12-14

DOI

10.5603/ARM.2017.0059

Pubmed

29288485

Bibliographic record

Adv Respir Med 2017;85(6):345-351.

Keywords

solitary pulmonary nodule
non-solid nodule
management strategy
chest imaging
lung neoplasms

Authors

Marcin Paśnik
Iwona Bestry
Kazimierz Roszkowski - Śliż

References (41)
  1. Brandman S, Ko JP. Pulmonary nodule detection, characterization, and management with multidetector computed tomography. J Thorac Imaging. 2011; 26(2): 90–105.
  2. Silva M, Pastorino U, Sverzellati N. Lung cancer screening with low-dose CT in Europe: strength and weakness of diverse independent screening trials. Clin Radiol. 2017; 72(5): 389–400.
  3. Alpert JB, Lowry CM, Ko JP. Imaging the solitary pulmonary nodule. Clin Chest Med. 2015; 36(2): 161–78, vii.
  4. Kikano GE, Fabien A, Schilz R. Evaluation of the solitary pulmonary nodule. (2015. www.aafp.org/afp.
  5. Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008; 246(3): 697–722.
  6. Siegelman SS, Khouri NF, Scott WW, et al. Pulmonary hamartoma: CT findings. Radiology. 1986; 160(2): 313–317.
  7. Chojniak R, Isberner RK, Viana LM, et al. Computed tomography guided needle biopsy: experience from 1,300 procedures. Sao Paulo Med J. 2006; 124(1): 10–14.
  8. Borczuk AC. Benign tumors and tumorlike conditions of the lung. Arch Pathol Lab Med. 2008; 132(7): 1133–1148.
  9. Travis WD, Brambilla E, Nicholson AG, et al. WHO Panel. The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification. J Thorac Oncol. 2015; 10(9): 1243–1260.
  10. Steele JD. The solitary pulmonary nodule. Report of a cooperative study of resected asymptomatic solitary pulmonary nodules in males. J Thorac Cardiovasc Surg. 1963; 46: 21–39.
  11. Arrigoni MG, Woolner LB, Bernatz PE, et al. Benign tumors of the lung. A ten-year surgical experience. J Thorac Cardiovasc Surg. 1970; 60(4): 589–599.
  12. Seo JB, Im JG, Goo JM, et al. Atypical pulmonary metastases: spectrum of radiologic findings. Radiographics. 2001; 21(2): 403–417.
  13. Feuerstein IM, Jicha DL, Pass HI, et al. Pulmonary metastases: MR imaging with surgical correlation--a prospective study. Radiology. 1992; 182(1): 123–129.
  14. Krzakowski M, Jassem J, Dziadziuszko R, et al. Zalecenia postępowania diagnostyczno-terapeutycznego w nowotworach złośliwych 2013 rok , Via Medica. ; 2013: 69–102.
  15. Strauss GM. Bronchiogenic carcinoma. Textbook of pulmonary diseases, 6th ed. Philadelphia, PA: Lippincott-Raven Publishers. ; 1998.
  16. Trichopoulos D, Mollo F, Tomatis L, et al. Active and passive smoking and pathological indicators of lung cancer risk in an autopsy study. JAMA. 1992; 268(13): 1697–1701.
  17. Fontham ET, Correa P, Reynolds P. Environmental tobacco smoke and lung cancer in nonsmoking women. A multicenter study. JAMA. 1994; 271: 1752–1759.
  18. Wojciechowska U, Olasek P, Czauderna K, Didkowska J. Nowotwory złośliwe w Polsce w 2014 roku. Centrum Onkologii – Instytut, Warszawa 2016.
  19. Winer-Muram HT. The solitary pulmonary nodule. Radiology. 2006; 239(1): 34–49.
  20. Klein JS, Zarka MA. Transthoracic needle biopsy: an overview. J Thorac Imaging. 1997; 12(4): 232–249.
  21. Honeybourne D, Babb J, Bowie P. British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax. 2001; 56 (Suppl 1): i1–21.
  22. Kundel HL. Predictive value and threshold detectability of lung tumors. Radiology. 1981; 139(1): 25–29.
  23. National Institute for Health and Clinical Excellence. The Diagnosis and Treatment of Lung Cancer NICE Clinical Guideline 121.
  24. Komaki R, Putnam JB, Walsh G, et al. The management of superior sulcus tumors. Semin Surg Oncol. 2000; 18(2): 152–164.
  25. Gould MK, Maclean CC, Kuschner WG, et al. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA. 2001; 285(7): 914–924.
  26. Webb WR, Higgins CB. Thoracic imaging. Lippincott Williams & Wilkins, Baltimore 2010.
  27. Holland JF, Bast RC, Morton DL, Frei E, Kufe DW, Weichselbaum RR. Cancer medicine. William & Wilkins, Baltimore 1997.
  28. Khouri NF, Meziane MA, Zerhouni EA, et al. The solitary pulmonary nodule. Assessment, diagnosis, and management. Chest. 1987; 91(1): 128–133.
  29. MacMahon H, Austin JHM, Gamsu G, et al. Fleischner Society. Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology. 2005; 237(2): 395–400.
  30. Henschke CI, Yankelevitz DF, Mirtcheva R, et al. CT screening for lung cancer: Frequency and significance of part-solid and nonsolid nodules. Am J Roentgenol. 2002; 178(5): 1053–1057.
  31. Truong MT, Ko JP, Rossi SE, et al. Update in the evaluation of the solitary pulmonary nodule. Radiographics. 2014; 34(6): 1658–1679.
  32. Mahoney MC, Shipley RT, Corcoran HL, et al. CT demonstration of calcification in carcinoma of the lung. AJR Am J Roentgenol. 1990; 154(2): 255–258.
  33. Li F, Sone S, Abe H, et al. Malignant versus benign nodules at CT screening for lung cancer: comparison of thin-section CT findings. Radiology. 2004; 233(3): 793–798.
  34. Hyodo T, Kanazawa S, Dendo S, et al. Intrapulmonary lymph nodes: thin-section CT findings, pathological findings, and CT differential diagnosis from pulmonary metastatic nodules. Acta Med Okayama. 2004; 58(5): 235–240.
  35. Woodring JH, Fried AM, Chuang VP. Solitary cavities of the lung: diagnostic implications of cavity wall thickness. AJR Am J Roentgenol. 1980; 135(6): 1269–1271.
  36. Aoki T, Nakata H, Watanabe H, et al. Evolution of peripheral lung adenocarcinomas: CT findings correlated with histology and tumor doubling time. AJR Am J Roentgenol. 2000; 174(3): 763–768.
  37. Henschke CI, Yankelevitz DF, Yip R, et al. Writing Committee for the I-ELCAP Investigators. Lung cancers diagnosed at annual CT screening: volume doubling times. Radiology. 2012; 263(2): 578–583.
  38. Swensen SJ, Brown LR, Colby TV, et al. Lung nodule enhancement at CT: prospective findings. Radiology. 1996; 201(2): 447–455.
  39. Ohno Y, Nishio M, Koyama H, et al. Dynamic contrast-enhanced CT and MRI for pulmonary nodule assessment. AJR Am J Roentgenol. 2014; 202(3): 515–529.
  40. Yamashita K, Matsunobe S, Tsuda T, et al. Solitary pulmonary nodule: preliminary study of evaluation with incremental dynamic CT. Radiology. 1995; 194(2): 399–405.
  41. Macmahon H, Naidich DP, Goo JM, et al. SPECIAL REPORT: Guidelines for Management of Incidental Pulmonary Nodules MacMahon. Radiology. 2017; 284(284).

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