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Ignore it or explore it: how to manage incidentally detected pulmonary nodules
Abstract
Patients with pulmonary nodules are not a homogenous group of individuals. Clearly, lung nodules in a smoker have a
different significance compared to those detected in an oncologic patient, or those seen in a young non-smoker with
no risk factors for malignant disease. Furthermore, there is increasing evidence that apart from clinical pretest
probability, the traditional morphologic criteria, nodule size and patient age are important factors in the construction
of a management model for patients with pulmonary nodules. Current management strategies for indeterminant small
pulmonary nodules have raised serious concerns, because they are partly flawed or, partly outdated. For example,
existing recommendations involve several follow-up CT examinations for every indeterminant nodule, regardless of its
size. Such elaborate follow-up protocols are not required for very small nodules, and particularly not when such
nodules are found incidentally in young non-smokers without a history of cancer. Furthermore, in young patients, the
risk from radiation must be weighted against the risk of missing a malignant disorder, or the risk arising from an
invasive diagnostic approach. As the risk of malignancy increases with nodule size, focal abnormalities with a diameter
of more than 8mm require a more aggressive and potentially invasive diagnostic approach to confirm or rule
out cancer. The aim of this presentation is to provide the audience with a practical approach to the management of
incidentally detected pulmonary nodules of various sizes in patients with different risk profiles for a malignant
pulmonary disorder, such as lung cancer.
Author
Christian Herold
Contact Details
Corresponding address:
Christian Herold, Department of Radiology, Medical University of Vienna - AKH,
Wahringer Gurtel 1820, A-1090 Vienna, Austria
Reference
ICIS Cancer Imaging Volume 7Special Issue A
DOI: 10.1102/1470-7330.2007.9006
Date Posted
1 October 2007
Open Access is provided for this article.
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