eMedicine Specialties > Pulmonology > Lung Tumors

Solitary Pulmonary Nodule: Follow-up

Author: Nader Kamangar, MD, FACP, FCCP, FAASM,, Associate Professor of Clinical Medicine, Director of Hospitalist/Intensivist Program, Division of Pulmonary, Critical Care and Sleep Medicine, David Geffen School of Medicine at University of California Los Angeles; Associate Director, Combined Pulmonary and Critical Care Fellowship Program, Cedars-Sinai/Olive View-UCLA/West Los Angeles Veterans Affairs Medical Center
Coauthor(s): Asif Alavi, MD, Resident Physician, Department of Internal Medicine, University of California, Los Angeles, David Geffen School of Medicine, Olive View Medical Center; Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital; Sri R Navaratnam, MBBS, PhD, FRCPC, Assistant Professor, Department of Internal Medicine, Section of Hematology/Oncology, University of Manitoba; Consulting Medical Oncologist, Department of Hematology/Oncology, Cancer Care Manitoba
Contributor Information and Disclosures

Updated: Sep 11, 2009

Follow-up

Deterrence/Prevention

Avoiding certain exposures may help prevent certain causes of solitary pulmonary nodule formation. Possible avoidable exposures include the following:

  • Risk factors for malignancy
    • Smoking
    • Occupational exposures (eg, asbestos, radon, nickel, chromium, vinyl chloride, polycyclic hydrocarbons)
  • Travel to areas endemic for mycosis (eg, histoplasmosis, coccidioidomycosis, blastomycosis) or to areas with a high prevalence of tuberculosis

Complications

Most solitary pulmonary nodules are benign, but they may represent an early stage of lung cancer. While lung cancer survival rates remain dismally low at 14% at 5 years, early lung cancer (ie, diagnosed when the primary tumor has a diameter smaller than 3 cm [stage 1A]) can be associated with a 5-year survival rate of 70-80%. Accordingly, the only chance for cure of early lung cancer manifesting as solitary pulmonary nodule is prompt diagnosis and management.

Miscellaneous

Medicolegal Pitfalls

Because a malignancy may be curable when present as a solitary pulmonary nodule (SPN), take great care in evaluating such masses. A comprehensive assessment generally includes history, physical examination, evaluation of previous chest radiographs, incorporation of other imaging studies (eg, CT scanning, positron-emission tomography [PET] scanning, single-photon emission computed tomography [SPECT] scanning), and invasive diagnostic procedures.

Because determining the retest probability of malignancy is essential in guiding the management of solitary pulmonary nodules, estimating the probability of benignity using a validated quantitative model might be an effective strategy. Bayesian analysis combines the radiologic features of a nodule and the clinical findings of an individual patient to estimate the probability of malignancy.

  • The radiographic features of solitary pulmonary nodules included in the Bayes analysis are size, edge, contour, cavity-wall thickness, and growth rate; the clinical parameters are smoking, age, previous malignancy, and hemoptysis. (These features and parameters have been derived from previously published series.)
  • The calculation of likelihood ratios and their use may result in fewer false-negative and false-positive results.21

Because the evidence is not definitive for many of the management guidelines, clinicians should discuss with patients the risks and benefits of alternative management options and should elicit patient preferences. The probability of malignancy only provides an estimation based on previously published studies and may not be generalized to an individual patient; therefore, patient preferences and clinician experience are important in planning further management strategies. Finally, because invasive procedures such as transthoracic needle aspiration (TTNA), transbronchial needle aspiration (TBNA), and video-assisted thoracoscopic surgery (VATS) may be associated with risks and complications, informed consent must be obtained.

 


More on Solitary Pulmonary Nodule

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Follow-up: Solitary Pulmonary Nodule
Multimedia: Solitary Pulmonary Nodule
References
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References

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Further Reading

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Keywords

solitary pulmonary nodule, SPN, early lung cancer, histoplasmosis, coccidioidomycosis, blastomycosis, pulmonary mycosis, tuberculosis, TB, bronchogenic carcinoma, nocardiosis, asbestos exposure, radon exposure, nickel exposure, chromium exposure, vinyl chloride exposure, polycyclic hydrocarbon exposure, chemical exposure, industrial exposure, bronchogenic cancer, bronchogenic malignancy, pulmonary mycosis, mycosis, lung nodule, malignant nodule, lung lesion, lung malignancy, neoplasm, primary neoplasm, lung neoplasm, granuloma, infectious granuloma, lung granuloma, benign lung lesion, hamartoma, lymphoma, carcinoid, fibroma, neurofibroma, blastoma, sarcoma, lung abscess, round pneumonia, hydatid cyst, rheumatoid arthritis, RA, Wegener granulomatosis, sarcoidosis, lipoid pneumonia, arteriovenous malformation, AVM, lung cyst, pulmonary infarct, round atelectasis, mucoid impaction, mucus impaction, progressive massive fibrosis

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Contributor Information and Disclosures

Author

Nader Kamangar, MD, FACP, FCCP, FAASM,, Associate Professor of Clinical Medicine, Director of Hospitalist/Intensivist Program, Division of Pulmonary, Critical Care and Sleep Medicine, David Geffen School of Medicine at University of California Los Angeles; Associate Director, Combined Pulmonary and Critical Care Fellowship Program, Cedars-Sinai/Olive View-UCLA/West Los Angeles Veterans Affairs Medical Center
Nader Kamangar, MD, FACP, FCCP, FAASM, is a member of the following medical societies: American Academy of Sleep Medicine, American Association of Bronchology, American College of Chest Physicians, American College of Physicians, American Lung Association, American Medical Association, American Thoracic Society, California Thoracic Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Asif Alavi, MD, Resident Physician, Department of Internal Medicine, University of California, Los Angeles, David Geffen School of Medicine, Olive View Medical Center
Asif Alavi, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital
Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association
Disclosure: Nothing to disclose.

Sri R Navaratnam, MBBS, PhD, FRCPC, Assistant Professor, Department of Internal Medicine, Section of Hematology/Oncology, University of Manitoba; Consulting Medical Oncologist, Department of Hematology/Oncology, Cancer Care Manitoba
Disclosure: Nothing to disclose.

Medical Editor

Stephen P Peters, MD, PhD, Professor, Department of Medicine, Wake Forest University
Stephen P Peters, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society, and Sigma Xi
Disclosure: See below for list of all activities None None

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

,, Kathy Roarty Placeholder
Disclosure: Nothing to disclose.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society
Disclosure: Nothing to disclose.

 
 
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