Diagnosis and management of pulmonary nodules_West China Medical Journal

Authors：

QIU Zhixin ,  LI Weimin

Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LI Weimin, Email: weimi003@yahoo.com

Keywords：

Pulmonary nodules; Diagnosis; Management

DOI：

10.7507/1002-0179.201712078

Video：

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Early diagnosis of lung cancer is difficult because of it’s lacking in distinctive clinical characteristics. With the development of CT technology for chest, the detection rate of pulmonary nodules is increasing year by year and acquires extensive attention. Therefore, the accurate clinical diagnosis to identify the character of solitary pulmonary nodules is urgently needed. However, the current clinical applications of different diagnosis have pluses and minuses. In this paper, we mainly review the diagnosis, management strategies and the existing problems of solitary pulmonary nodules based on the cancer-screening guidelines of Fleischner Society, American College of Chest Physicians, National Comprehensive Cancer Network, Evaluation of Pulmonary Nodules: Clinical Practice Consensus Guidelines for Asia, and Chinese Consensus on Pulmonary Nodules, and clinical research progress of pulmonary nodules.

Citation： QIU Zhixin, LI Weimin. Diagnosis and management of pulmonary nodules. West China Medical Journal, 2018, 33(1): 8-14. doi: 10.7507/1002-0179.201712078 Copy

1.	Harzheim D, Eberhardt R, Hoffmann H, et al. The solitary pulmonary nodule. Respiration, 2015, 90(2): 160-172.
2.	Callister ME, Baldwin DR, Akram AR, et al. British thoracic society guidelines for theinvestigation and management of pulmonary nodules. Thorax, 2015, 70(Suppl 2): ii1-ii54.
3.	National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
4.	王俊, 刘彦国. 肺内小结节的诊治现状、问题和方向. 中华胸心血管外科杂志, 2012, 28(7): 385-386, 389.
5.	Kim HY, Shim YM, Lee KS, et al. Persistent pulmonary nodular ground-glass opacity at thin-section CT: histopathologic comparisons. Radiology, 2007, 245(1): 267-275.
6.	Patel VK, Naik SK, Naidich DP, et al. A practical algorithmic approach to the diagnosis and management of solitary pulmonary nodules: part 1: radiologic characteristics and imaging modalities. Chest, 2013, 143(3): 825-839.
7.	Austin JH, Garg K, Aberle D, et al. Radiologic implications of the 2011 classification of adenocarcinoma of the lung. Radiology, 2013, 266(1): 62-71.
8.	Beigelman-Aubry C, Hill C, Grenier PA. Management of an incidentally discovered pulmonary nodule. Eur Radiol, 2007, 17(2): 449-466.
9.	Doo KW, Kang EY, Yong HS, et al. Comparison of chest radiography, chest digital tomosynthesis and low dose MDCT to detect small ground-glass opacity nodules: an anthropomorphic chest phantom study. Eur Radiol, 2014, 24(12): 3269-3276.
10.	Ohno Y, Nishio M, Koyama H, et al. Solitary pulmonary nodules: comparison of dynamic first-pass contrast-enhanced perfusion area-detector CT, dynamic first-pass contrast-enhanced Mr imaging, and FDG PET/CT. Radiology, 2015, 274(2): 563-575.
11.	Horeweg N, Van Rosmalen J, Heuvelmans MA, et al. Lung cancer probability in patients with CT-detected pulmonary nodules: a prespecified analysis of data from the NELSON trial of low-dose CT screening. Lancet Oncol, 2014, 15(12): 1332-1341.
12.	Ettinger DS, Wood DE, Akerley W, et al. Non-small cell lung cancer, Version 6.2015. J Natl Compr Canc Netw, 2015, 13(5): 515-524.
13.	Park CM, Goo JM, Lee HJ, et al. Nodular ground-glass opacity at thin-section CT: histologic correlation and evaluation of change at follow-up. Radiographics, 2007, 27(2): 391-408.
14.	Yilmaz F, Tastekin G. Sensitivity of (18)F-FDG PET in evaluation of solitary pulmonary nodules. Int J Clin Exp Med, 2015, 8(1): 45-51.
15.	Dabrowska M, Krenke R, Korczynski P, et al. Diagnostic accuracy of contrast-enhanced computed tomography and positron emission tomography with 18-FDG in identifying malignant solitary pulmonary nodules. Medicine (Baltimore), 2015, 94(15): e666.
16.	Callahan J, Kron T, Schneider ME, et al. A prospective investigation into the clinical impact of 4D-PET/CT in the characterisation of solitary pulmonary nodules. Cancer Imaging, 2014, 14: 24.
17.	Demir Y, Polack BD, Karaman C, et al. The diagnostic role of dual-phase (18)F-FDG PET/CT in the characterization of solitary pulmonary nodules. Nucl Med Commun, 2014, 35(3): 260-267.
18.	Alkhawaldeh K, Bural G, Kumar R, et al. Impact of dual-time-point (18)F-FDG PET imaging and partial volume correction in the assessment of solitary pulmonary nodules. Eur J Nucl Med Mol Imaging, 2008, 35(2): 246-252.
19.	Koyama H, Ohno Y, Seki S, et al. Value of diffusion-weighted Mr imaging using various parameters for assessment and characterization of solitary pulmonary nodules. Eur J Radiol, 2015, 84(3): 509-515.
20.	Sommer G, Koenigkam-Santos M, Biederer J, et al. Role of MRI for detection and characterization of pulmonary nodules. Radiologe, 2014, 54(5): 470-477.
21.	Sommer G, Tremper J, Koenigkam-Santos M, et al. Lung nodule detection in a high-risk population: comparison of magnetic resonance imaging and low-dose computed tomography. Eur J Radiol, 2014, 83(3): 600-605.
22.	Rivera MP, Mehta AC. Initial diagnosis of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 131S-148S.
23.	Paone G, Nicastri E, Lucantoni G, et al. D’angeli AL, Galluccio G: endobronchial ultrasound-driven biopsy in the diagnosis of peripheral lung lesions. Chest, 2005, 128(5): 3551-3557.
24.	Chavez C, Sasada S, Izumo T, et al. Endobronchial ultrasound with a guide sheath for small malignant pulmonary nodules: a retrospective comparison between central and peripheral locations. J Thorac Dis, 2015, 7(4): 596-602.
25.	Minami D, Takigawa N, Morichika D, et al. Endobronchial ultrasound-guided transbronchial biopsy with or without a guide sheath for diagnosis of lung cancer. Respir Investig, 2015, 53(5): 93-97.
26.	Hayama M, Izumo T, Matsumoto Y, et al. Complications with endobronchial ultrasound with a guide sheath for the diagnosis of peripheral pulmonary lesions. Respiration, 2015, 90(2): 129-135.
27.	Diken OE, Karnak D, Ciledag A, et al. Electromagnetic navigation-guided TBNA vs conventional TBNA in the diagnosis of mediastinal lymphadenopathy. Clin Respir J, 2015, 9(2): 214-220.
28.	Gex G, Pralong JA, Combescure C, et al. Diagnostic yield and safety of electromagnetic navigation bronchoscopy for lung nodules: a systematic review and meta-analysis. Respiration, 2014, 87(2): 165-176.
29.	Tomiyama N, Yasuhara Y, Nakajima YA, et al. CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol, 2006, 59(1): 60-64.
30.	Gould MK, Donington J, Lynch WR, et al. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e93S-120S.
31.	Horeweg N, van Rosmalen J, Heuvelmans MA, et al. Lung cancer probability in patients with CT-detected pulmonary nodules: a prespecified analysis of data from the NELSON trial of low-dose CT sereening. Lancet Oncol, 2014, 15(12): 1332-1341.
32.	Dabrowska M, Krenke R, Korczynski P, et al. Diagnostic accuracy of contrast-enhanced computed tomography and positron emission tomography with 18-FDG in identifying malignant solitary pulmonary nodules. Medicine (Baltimore), 2015, 94(15): e666.
33.	Heo EY, Lee KW, Jheon S, et al. Surgical resection of highly suspicious pulmonary nodules without a tissue diagnosis. Jpn J Clin Oncol, 2011, 41(8): 1017-1022.
34.	Callahan J, Kron T, Schneider ME, et al. A prospective investigation into the clinical impact of 4D-PET/CT in the characterisation of solitary pulmonary nodules. Cancer Imaging, 2014, 14: 24.
35.	Dabrowska M, Krenke R, Korczynski P, et al. Diagnostic accuracy of contrast-enhanced computed tomography and positron emission tomography with 18-FDG in identifying malignant solitary pulmonary nodules. Medicine (Bahimnre), 2015, 94(15): e666.
36.	Qiu ZX, Cheng Y, Liu D, et al. Clinical, pathological, and radiological characteristics of solitary ground-glass opacity lung nodules on high-resolution computed tomography. Ther Clin Risk Manag, 2016, 12: 1445-1453.
37.	Mcwilliams A, Tammemagi MC, Mayo JR, et al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med, 2013, 369(10): 910-919.
38.	Macmahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: from the fleischner society 2017. Radiology, 2017, 284(1): 228-243.
39.	Wood DE. National comprehensive cancer network (NCCN) clinical practice guidelines for non-small cell lung cancer. (2017-02-14)[2017-12-15]. https://www.sogou.com/link?url= hedJjaC291MhLETz0L7YcpJwwDvLU4JjIX_0JIGfE_Awcjzte8zJ7s45CRjnu8ZxEYJUcF2GtqVMNqTewGyLTA.
40.	Bai C, Choi CM, Chu CM, et al. Evaluation of pulmonary nodules: clinical practice consensus guidelines for Asia. Chest, 2016, 150(4): 877-893.

1. Harzheim D, Eberhardt R, Hoffmann H, et al. The solitary pulmonary nodule. Respiration, 2015, 90(2): 160-172.
2. Callister ME, Baldwin DR, Akram AR, et al. British thoracic society guidelines for theinvestigation and management of pulmonary nodules. Thorax, 2015, 70(Suppl 2): ii1-ii54.
3. National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
4. 王俊, 刘彦国. 肺内小结节的诊治现状、问题和方向. 中华胸心血管外科杂志, 2012, 28(7): 385-386, 389.
5. Kim HY, Shim YM, Lee KS, et al. Persistent pulmonary nodular ground-glass opacity at thin-section CT: histopathologic comparisons. Radiology, 2007, 245(1): 267-275.
6. Patel VK, Naik SK, Naidich DP, et al. A practical algorithmic approach to the diagnosis and management of solitary pulmonary nodules: part 1: radiologic characteristics and imaging modalities. Chest, 2013, 143(3): 825-839.
7. Austin JH, Garg K, Aberle D, et al. Radiologic implications of the 2011 classification of adenocarcinoma of the lung. Radiology, 2013, 266(1): 62-71.
8. Beigelman-Aubry C, Hill C, Grenier PA. Management of an incidentally discovered pulmonary nodule. Eur Radiol, 2007, 17(2): 449-466.
9. Doo KW, Kang EY, Yong HS, et al. Comparison of chest radiography, chest digital tomosynthesis and low dose MDCT to detect small ground-glass opacity nodules: an anthropomorphic chest phantom study. Eur Radiol, 2014, 24(12): 3269-3276.
10. Ohno Y, Nishio M, Koyama H, et al. Solitary pulmonary nodules: comparison of dynamic first-pass contrast-enhanced perfusion area-detector CT, dynamic first-pass contrast-enhanced Mr imaging, and FDG PET/CT. Radiology, 2015, 274(2): 563-575.
11. Horeweg N, Van Rosmalen J, Heuvelmans MA, et al. Lung cancer probability in patients with CT-detected pulmonary nodules: a prespecified analysis of data from the NELSON trial of low-dose CT screening. Lancet Oncol, 2014, 15(12): 1332-1341.
12. Ettinger DS, Wood DE, Akerley W, et al. Non-small cell lung cancer, Version 6.2015. J Natl Compr Canc Netw, 2015, 13(5): 515-524.
13. Park CM, Goo JM, Lee HJ, et al. Nodular ground-glass opacity at thin-section CT: histologic correlation and evaluation of change at follow-up. Radiographics, 2007, 27(2): 391-408.
14. Yilmaz F, Tastekin G. Sensitivity of (18)F-FDG PET in evaluation of solitary pulmonary nodules. Int J Clin Exp Med, 2015, 8(1): 45-51.
15. Dabrowska M, Krenke R, Korczynski P, et al. Diagnostic accuracy of contrast-enhanced computed tomography and positron emission tomography with 18-FDG in identifying malignant solitary pulmonary nodules. Medicine (Baltimore), 2015, 94(15): e666.
16. Callahan J, Kron T, Schneider ME, et al. A prospective investigation into the clinical impact of 4D-PET/CT in the characterisation of solitary pulmonary nodules. Cancer Imaging, 2014, 14: 24.
17. Demir Y, Polack BD, Karaman C, et al. The diagnostic role of dual-phase (18)F-FDG PET/CT in the characterization of solitary pulmonary nodules. Nucl Med Commun, 2014, 35(3): 260-267.
18. Alkhawaldeh K, Bural G, Kumar R, et al. Impact of dual-time-point (18)F-FDG PET imaging and partial volume correction in the assessment of solitary pulmonary nodules. Eur J Nucl Med Mol Imaging, 2008, 35(2): 246-252.
19. Koyama H, Ohno Y, Seki S, et al. Value of diffusion-weighted Mr imaging using various parameters for assessment and characterization of solitary pulmonary nodules. Eur J Radiol, 2015, 84(3): 509-515.
20. Sommer G, Koenigkam-Santos M, Biederer J, et al. Role of MRI for detection and characterization of pulmonary nodules. Radiologe, 2014, 54(5): 470-477.
21. Sommer G, Tremper J, Koenigkam-Santos M, et al. Lung nodule detection in a high-risk population: comparison of magnetic resonance imaging and low-dose computed tomography. Eur J Radiol, 2014, 83(3): 600-605.
22. Rivera MP, Mehta AC. Initial diagnosis of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 131S-148S.
23. Paone G, Nicastri E, Lucantoni G, et al. D’angeli AL, Galluccio G: endobronchial ultrasound-driven biopsy in the diagnosis of peripheral lung lesions. Chest, 2005, 128(5): 3551-3557.
24. Chavez C, Sasada S, Izumo T, et al. Endobronchial ultrasound with a guide sheath for small malignant pulmonary nodules: a retrospective comparison between central and peripheral locations. J Thorac Dis, 2015, 7(4): 596-602.
25. Minami D, Takigawa N, Morichika D, et al. Endobronchial ultrasound-guided transbronchial biopsy with or without a guide sheath for diagnosis of lung cancer. Respir Investig, 2015, 53(5): 93-97.
26. Hayama M, Izumo T, Matsumoto Y, et al. Complications with endobronchial ultrasound with a guide sheath for the diagnosis of peripheral pulmonary lesions. Respiration, 2015, 90(2): 129-135.
27. Diken OE, Karnak D, Ciledag A, et al. Electromagnetic navigation-guided TBNA vs conventional TBNA in the diagnosis of mediastinal lymphadenopathy. Clin Respir J, 2015, 9(2): 214-220.
28. Gex G, Pralong JA, Combescure C, et al. Diagnostic yield and safety of electromagnetic navigation bronchoscopy for lung nodules: a systematic review and meta-analysis. Respiration, 2014, 87(2): 165-176.
29. Tomiyama N, Yasuhara Y, Nakajima YA, et al. CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol, 2006, 59(1): 60-64.
30. Gould MK, Donington J, Lynch WR, et al. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e93S-120S.
31. Horeweg N, van Rosmalen J, Heuvelmans MA, et al. Lung cancer probability in patients with CT-detected pulmonary nodules: a prespecified analysis of data from the NELSON trial of low-dose CT sereening. Lancet Oncol, 2014, 15(12): 1332-1341.
32. Dabrowska M, Krenke R, Korczynski P, et al. Diagnostic accuracy of contrast-enhanced computed tomography and positron emission tomography with 18-FDG in identifying malignant solitary pulmonary nodules. Medicine (Baltimore), 2015, 94(15): e666.
33. Heo EY, Lee KW, Jheon S, et al. Surgical resection of highly suspicious pulmonary nodules without a tissue diagnosis. Jpn J Clin Oncol, 2011, 41(8): 1017-1022.
34. Callahan J, Kron T, Schneider ME, et al. A prospective investigation into the clinical impact of 4D-PET/CT in the characterisation of solitary pulmonary nodules. Cancer Imaging, 2014, 14: 24.
35. Dabrowska M, Krenke R, Korczynski P, et al. Diagnostic accuracy of contrast-enhanced computed tomography and positron emission tomography with 18-FDG in identifying malignant solitary pulmonary nodules. Medicine (Bahimnre), 2015, 94(15): e666.
36. Qiu ZX, Cheng Y, Liu D, et al. Clinical, pathological, and radiological characteristics of solitary ground-glass opacity lung nodules on high-resolution computed tomography. Ther Clin Risk Manag, 2016, 12: 1445-1453.
37. Mcwilliams A, Tammemagi MC, Mayo JR, et al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med, 2013, 369(10): 910-919.
38. Macmahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: from the fleischner society 2017. Radiology, 2017, 284(1): 228-243.
39. Wood DE. National comprehensive cancer network (NCCN) clinical practice guidelines for non-small cell lung cancer. (2017-02-14)[2017-12-15]. https://www.sogou.com/link?url= hedJjaC291MhLETz0L7YcpJwwDvLU4JjIX_0JIGfE_Awcjzte8zJ7s45CRjnu8ZxEYJUcF2GtqVMNqTewGyLTA.
40. Bai C, Choi CM, Chu CM, et al. Evaluation of pulmonary nodules: clinical practice consensus guidelines for Asia. Chest, 2016, 150(4): 877-893.

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