the lecture approaches the problem of solitary pulmonary nodule in terms of variable imaging findings,differential diagnosis and algorithm of follow up .
3. SPN
Ii is defined as a focal opacity ,visible on chest
radiograph or CT ,with the following criteria :
1.Relatively well defined .
2.Surrounded-at least partially - by lung .
3.Roughly spherical in shape.
4.3 cm or less in diameter (more than 3 cm is
termed mass )
4.
5. Clinical evaluation
Hx of smoking.
Age over 40.
Occupational exposure.
Lung fibrosis.
COPD.
Family Hx of Lung cancer.
Travel History
TB skin test.
Other diseases (Rheumatoid arthritis )
Malignancy .(solitary metastasis or increased likelihood of 1ry
bronchogenic Ca for H & N breast ,bile ducts ,oes. ,cervix
,bladder ,prostate ,etc up to 3 folds )
8. I-Morphological Characteristics
Size : Diameter Malignancy
The likelihood of rate
malignancy is directly 1cm> 35%
related to size reaching
more than 85 % for SPN
more than 2 cm . cm 1-2 50%
cm 2-3 80%
9. Location :
2/3 of lung cancers occur in upper lobes.
60% seen in lung periphery .
Only 10 % seen in medial third .
Mets tend to be subpleural or outer 1/3 of
lung.
2/3 of mets are in lower lobes.
10. Edge Appearance :
90% of lesions with irregular or spiculated edges
are malignant.
20% only of well defined lesions are malignant
(e.g.: Mets or carcinoid tumor )
Corona Maligna or radiata represent either
desmoplastic reaction around the tumor or
actual invasion of surrounding lung …common
with BAC and adenocarcinoma
18. Halo sign
Halo of ground glass opacity surrounding a
nodule .
Commonly present in Leukemic patient with
invasive aspergillosis (represent hemorrhagic
infarction )
Can occur with any other infections .
Can be seen with BAC and adenocarcinoma
(representing lepidic growth )
22. Shape :
Lung Ca tends to be irregular , lobulated or
notched.
Granuloma are rounded.
Hamartoma and metastasis are round ,oval or
lobulated.
Scars , atelectasis may appear linear .
AVM and mucous plugs are particular in shape
40. III-Growth
Doubling time is the time required for a lesion
to double its volume .
26% increase in nodule diameter is one doubling
Doubling of diameter is 3 volume doublings.
Range of doubling time of carcinomas is 1
week to 16 months.
Doubling time <1 month or >200 days is likely
to be benign .
No growth over 2 years most likely benign.
41. ?How to evaluate
.See prior examinations
If not available
Small lesions follow up is at 3,6 months ,1 and 2
.year
Very small lesions (3mm)..yearly follow up
42.
43. SPECT & PET Scan additions
Using FDG high activity in PET is associated
with malignancy