Evidence Based Imaging Strategies for Solitary Pulmonary Nodule_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 Yi-XiangJ. Wang ¹ , Jing-ShanGong ² , KenjiSuzuki ³ , SamehK. Morcos ⁴

1. Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China;
2. Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China;
3. Department of Radiology, The University of Chicago, Chicago, IL 60637, USA;
4. Diagnostic Imaging, The University of Sheffield, Sheffield, UK;

Corresponding author：

Yi-XiangJ. Wang, Email: yixiang-wang@cuhk.edu.hk

Keywords：

Pulmonary nodule; Computerized tomography; Follow-up; Positron emission tomography (PET); Magnetic resonance imaging; Guideline; Biopsy; Lung cancer

DOI：

10.7507/1007-4848.20150095

Video：

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Abstract Full text Figures/Tables Video References Cited by

Solitary pulmonary nodule (SPN) is defined as a rounded opacity≤3 cm in diameter surrounded by lung parenchyma. The majority of smokers who undergo thin-section CT have SPNs, most of which are smaller than 7 mm. In the past, multiple follow-up examinations over a two-year period, including CT follow-up at 3, 6, 12, 18, and 24 months, were recommended when such nodules are detected incidentally. This policy increases radiation burden for the affected population. Nodule features such as shape, edge characteristics, cavitation, and location have not yet been found to be accurate for distinguishing benign from malignant nodules. When SPN is considered to be indeterminate in the initial exam, the risk factor of the patients should be evaluated, which includes patients' age and smoking history. The 2005 Fleischner Society guideline stated that at least 99% of all nodules 4 mm or smaller are benign; when nodule is 5-9 mm in diameter, the best strategy is surveillance. The timing of these control examinations varies according to the nodule size (4-6, or 6-8 mm) and the type of patients, specifically at low or high risk of malignancy concerned. Noncalcified nodules larger than 8 mm diameter bear a substantial risk of malignancy, additional options such as contrast material-enhanced CT, positron emission tomography (PET), percutaneous needle biopsy, and thoracoscopic resection or videoassisted thoracoscopic resection should be considered.

Citation： Yi-XiangJ. Wang, Jing-ShanGong, KenjiSuzuki, SamehK. Morcos. Evidence Based Imaging Strategies for Solitary Pulmonary Nodule. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(4): 355-360. doi: 10.7507/1007-4848.20150095 Copy

1.	Hansell DM, Bankier AA, MacMahon H, et al.Fleischner Society:glossary of terms for thoracic imaging.Radiology, 2008, 246(3):697-722.
2.	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.
3.	Swensen SJ, Silverstein MD, Ilstrup DM, et al.The probability of malignancy in solitary pulmonary nodules.Application to small radiologically indeterminate nodules.Arch Intern Med, 1997, 157(8):849-855.
4.	Swensen SJ.CT screening for lung cancer.Am J Roentgenol, 2002, 179:833-836.
5.	Wahidi MM, Govert JA, Goudar RK, et al.Evidence for the treat-ment of patients with pulmonary nodules:when is it lung cancer?ACCP evidence-based clinical practice guidelines (2nd edition).Chest, 2007, 132(3 suppl):94S-107S.
6.	Henschke CI, Yankelevitz DF, Naidich DP, et al.CT screening for lung cancer:suspiciousness of nodules according to size on baseline scans.Radiology, 2004, 231(1):164-168.
7.	Swensen SJ, Jett JR, Hartman T, et al.Screening for lung cancer with CT:Mayo Clinic experience.Radiology, 2003, 226(3):756-761.
8.	Henschke CI, McCauley DI, Yankelevitz DF, et al.Early Lung Cancer Action Project:overall design and findings from baseline screening.Lancet, 1999, 354(9173):99-105.
9.	Henschke CI, Naidich DP, Yankelevitz DF, et al.Early Lung Cancer Action Project:initial findings on repeat screening.Cancer, 2001, 92(1):153-159.
10.	Diederich S, Wormanns D, Lenzen H, et al.Screening for asymptomatic early bronchogenic carcinoma with low dose CT of the chest.Cancer, 2000, 89(11Suppl):2483-2484.
11.	Ost D, Fein AM, Feinsilver SH.The solitary pulmonary nodule.N Engl J Med, 2003, 348:2535-2542.
12.	Tan BB, Flaherty KR, et al.American College of Chest Physicians.The solitary pulmonary nodule.Chest, 2003, 123(suppl 1):89S-96S.
13.	Mayo JR, Alrich J, Muller NL.Radiation exposure at chest CT:a statement of the Fleischner Society.Radiology, 2003, 228:15-21.
14.	Imhof H, Schibany N, Ba-Ssalamah A, et al.Spiral CT and radiation dose.Eur J Radiol, 2003, 47:29-37.
15.	Kalra MK, Maher MM, Toth TL, et al.Strategies for CT radiation dose optimization.Radiology, 2004, 230:619-628.
16.	Brenner DJ.Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer.Radiology, 2004, 231:440-444.
17.	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.
18.	Brandman S, Ko JP.Pulmonary nodule detection, characterization, and management with multidetector computed tomography.J Thorac Imaging, 2011, 26(2):90-105.
19.	Batra P, Brown K, Hayashi K, et al.Rounded atelectasis.J Thorac Imaging, 1996, 11:187-97.
20.	Erasmus JJ, Connolly JE, McAdams HP, et al.Solitary pulmonary nodules.I.Morphologic evaluation for differentiation of benign and malignant lesions.RadioGraphics, 2000, 20:43-58.
21.	U.S.Department of Health and Human Services.The health consequences of smoking:a report of the surgeon general.Atlanta, Ga:U.S.Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1982.
22.	Guyatt GH, Newhouse MD.Are active and passive smoking harmful?Determination of causation.Chest, 1985, 88:445-451.
23.	MacMahon H, Austin JH, Gamsu G, et al.Guidelines for manage-ment of small pulmonary nodules detected on CT scans:a statement from the Fleischner Society.Radiology, 2005, 237(2):395-400.
24.	Henschke CI, Yankelevitz DF, Mirtcheva R, et al.CT screening for lung cancer:frequency and significance of part-solid and nonsolid nodules.AJR Am J Roentgenol, 2002, 178(5):1053-1057.
25.	Godoy MC, Naidich DP.Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung:recommended interim guidelines for assessment and management.Radiology, 2009, 253(3):606-622.
26.	Hasegawa M, Sone S, Takashima S, et al.Growth rate of small lung cancers detected on mass CT screening.Br J Radiol, 2000, 73(876):1252-1259.
27.	Aoki T, Nakata H, Watanabe H, et al.Evolution of peripheral lung adenocarcinomas:CT findings correlated with histology and tumor doubling time.Am J Roentgenol, 2000, 174(3):763-768.
28.	de Hoop B, Gietema H, van de Vorst S, et al.Pulmonary ground-glass nodules:increase in mass as an early indicator of growth.Radiology, 2010, 255(1):199-206.
29.	Kakinuma R, Ohmatsu H, Kaneko M, et al.Progression of focal pure ground-glass opacity detected by low-dose helical computed tomography screening for lung cancer.J Comput Assist Tomogr, 2004, 28(1):17-23.
30.	Naidich DP, Bankier AA, MacMahon H, et al.Recommendations for the management of subsolid pulmonary nodules detected at CT:a statement from the Fleischner Society.Radiology, 2013, 266(1):304-317.
31.	Cronin P, Dwamena BA, Kelly AM, et al.Solitary pulmonary nodules:meta-analytic comparison of cross sectional imaging modalities for diagnosis of malignancy.Radiology, 2008, 246(3):772-782.
32.	Schmid RA, Hillinger S, Bruchhaus H, et al.The value of positron emission tomography (FDG PET) in detecting extrathoracic metastases in non-small cell lung cancer.Am J Respir Crit Care Med, 1998, 157:A256.
33.	Martini N, Flehinger BJ, Zaman MB, et al.Prospective study of 445 lung carcinomas with mediastinal lymph node metastases.J Thorac Cardiovasc Surg, 1980, 80(3):390-399.
34.	Deppen S, Putnam JB Jr, Andrade G, et al.Accuracy of FDG-PET to diagnose lung cancer in a region of endemic granulomatous disease.Ann Thorac Surg, 2011, 92(2):428-432.
35.	Orlacchio A, Schillaci O, Antonelli L, et al.Solitary pulmonary nodules:morphological and metabolic characterisation by FDG-PET-MDCT.Radiol Med, 2007, 112(2):157-173.
36.	Van Tassel D, Tassel LV, Gotway MB, et al.Imaging evaluation of the solitary pulmonary nodule.Clin Pulm Med, 2011, 18:274-299.
37.	Sim YT, Poon FW.Imaging of solitary pulmonary nodule-a clinical review.Quant Imaging Med Surg, 2013, 3(6):316-326.
38.	Conces DJ Jr, Schwenk GR Jr, Doering PR, et al.Thoracic needle biopsy:improved results utilizing a team approach.Chest, 1987, 91(6):813-816.
39.	Berquist TH, Bailey PB, Cortese DA, et al.Transthoracic needle biopsy:accuracy and complications in relation to location and type of lesion.Mayo Clin Proc, 1980, 55(8):475-481.
40.	Eisenberg RL, Bankier AA, et al.Compliance with Fleischner Society guidelines for management of small lung nodules:a survey of 834 radiologists.Radiology, 2010, 255(1):218-224.

1. Hansell DM, Bankier AA, MacMahon H, et al.Fleischner Society:glossary of terms for thoracic imaging.Radiology, 2008, 246(3):697-722.
2. 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.
3. Swensen SJ, Silverstein MD, Ilstrup DM, et al.The probability of malignancy in solitary pulmonary nodules.Application to small radiologically indeterminate nodules.Arch Intern Med, 1997, 157(8):849-855.
4. Swensen SJ.CT screening for lung cancer.Am J Roentgenol, 2002, 179:833-836.
5. Wahidi MM, Govert JA, Goudar RK, et al.Evidence for the treat-ment of patients with pulmonary nodules:when is it lung cancer?ACCP evidence-based clinical practice guidelines (2nd edition).Chest, 2007, 132(3 suppl):94S-107S.
6. Henschke CI, Yankelevitz DF, Naidich DP, et al.CT screening for lung cancer:suspiciousness of nodules according to size on baseline scans.Radiology, 2004, 231(1):164-168.
7. Swensen SJ, Jett JR, Hartman T, et al.Screening for lung cancer with CT:Mayo Clinic experience.Radiology, 2003, 226(3):756-761.
8. Henschke CI, McCauley DI, Yankelevitz DF, et al.Early Lung Cancer Action Project:overall design and findings from baseline screening.Lancet, 1999, 354(9173):99-105.
9. Henschke CI, Naidich DP, Yankelevitz DF, et al.Early Lung Cancer Action Project:initial findings on repeat screening.Cancer, 2001, 92(1):153-159.
10. Diederich S, Wormanns D, Lenzen H, et al.Screening for asymptomatic early bronchogenic carcinoma with low dose CT of the chest.Cancer, 2000, 89(11Suppl):2483-2484.
11. Ost D, Fein AM, Feinsilver SH.The solitary pulmonary nodule.N Engl J Med, 2003, 348:2535-2542.
12. Tan BB, Flaherty KR, et al.American College of Chest Physicians.The solitary pulmonary nodule.Chest, 2003, 123(suppl 1):89S-96S.
13. Mayo JR, Alrich J, Muller NL.Radiation exposure at chest CT:a statement of the Fleischner Society.Radiology, 2003, 228:15-21.
14. Imhof H, Schibany N, Ba-Ssalamah A, et al.Spiral CT and radiation dose.Eur J Radiol, 2003, 47:29-37.
15. Kalra MK, Maher MM, Toth TL, et al.Strategies for CT radiation dose optimization.Radiology, 2004, 230:619-628.
16. Brenner DJ.Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer.Radiology, 2004, 231:440-444.
17. 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.
18. Brandman S, Ko JP.Pulmonary nodule detection, characterization, and management with multidetector computed tomography.J Thorac Imaging, 2011, 26(2):90-105.
19. Batra P, Brown K, Hayashi K, et al.Rounded atelectasis.J Thorac Imaging, 1996, 11:187-97.
20. Erasmus JJ, Connolly JE, McAdams HP, et al.Solitary pulmonary nodules.I.Morphologic evaluation for differentiation of benign and malignant lesions.RadioGraphics, 2000, 20:43-58.
21. U.S.Department of Health and Human Services.The health consequences of smoking:a report of the surgeon general.Atlanta, Ga:U.S.Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1982.
22. Guyatt GH, Newhouse MD.Are active and passive smoking harmful?Determination of causation.Chest, 1985, 88:445-451.
23. MacMahon H, Austin JH, Gamsu G, et al.Guidelines for manage-ment of small pulmonary nodules detected on CT scans:a statement from the Fleischner Society.Radiology, 2005, 237(2):395-400.
24. Henschke CI, Yankelevitz DF, Mirtcheva R, et al.CT screening for lung cancer:frequency and significance of part-solid and nonsolid nodules.AJR Am J Roentgenol, 2002, 178(5):1053-1057.
25. Godoy MC, Naidich DP.Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung:recommended interim guidelines for assessment and management.Radiology, 2009, 253(3):606-622.
26. Hasegawa M, Sone S, Takashima S, et al.Growth rate of small lung cancers detected on mass CT screening.Br J Radiol, 2000, 73(876):1252-1259.
27. Aoki T, Nakata H, Watanabe H, et al.Evolution of peripheral lung adenocarcinomas:CT findings correlated with histology and tumor doubling time.Am J Roentgenol, 2000, 174(3):763-768.
28. de Hoop B, Gietema H, van de Vorst S, et al.Pulmonary ground-glass nodules:increase in mass as an early indicator of growth.Radiology, 2010, 255(1):199-206.
29. Kakinuma R, Ohmatsu H, Kaneko M, et al.Progression of focal pure ground-glass opacity detected by low-dose helical computed tomography screening for lung cancer.J Comput Assist Tomogr, 2004, 28(1):17-23.
30. Naidich DP, Bankier AA, MacMahon H, et al.Recommendations for the management of subsolid pulmonary nodules detected at CT:a statement from the Fleischner Society.Radiology, 2013, 266(1):304-317.
31. Cronin P, Dwamena BA, Kelly AM, et al.Solitary pulmonary nodules:meta-analytic comparison of cross sectional imaging modalities for diagnosis of malignancy.Radiology, 2008, 246(3):772-782.
32. Schmid RA, Hillinger S, Bruchhaus H, et al.The value of positron emission tomography (FDG PET) in detecting extrathoracic metastases in non-small cell lung cancer.Am J Respir Crit Care Med, 1998, 157:A256.
33. Martini N, Flehinger BJ, Zaman MB, et al.Prospective study of 445 lung carcinomas with mediastinal lymph node metastases.J Thorac Cardiovasc Surg, 1980, 80(3):390-399.
34. Deppen S, Putnam JB Jr, Andrade G, et al.Accuracy of FDG-PET to diagnose lung cancer in a region of endemic granulomatous disease.Ann Thorac Surg, 2011, 92(2):428-432.
35. Orlacchio A, Schillaci O, Antonelli L, et al.Solitary pulmonary nodules:morphological and metabolic characterisation by FDG-PET-MDCT.Radiol Med, 2007, 112(2):157-173.
36. Van Tassel D, Tassel LV, Gotway MB, et al.Imaging evaluation of the solitary pulmonary nodule.Clin Pulm Med, 2011, 18:274-299.
37. Sim YT, Poon FW.Imaging of solitary pulmonary nodule-a clinical review.Quant Imaging Med Surg, 2013, 3(6):316-326.
38. Conces DJ Jr, Schwenk GR Jr, Doering PR, et al.Thoracic needle biopsy:improved results utilizing a team approach.Chest, 1987, 91(6):813-816.
39. Berquist TH, Bailey PB, Cortese DA, et al.Transthoracic needle biopsy:accuracy and complications in relation to location and type of lesion.Mayo Clin Proc, 1980, 55(8):475-481.
40. Eisenberg RL, Bankier AA, et al.Compliance with Fleischner Society guidelines for management of small lung nodules:a survey of 834 radiologists.Radiology, 2010, 255(1):218-224.

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