Tuesday, February 28, 2006

More pulmonary nodules


We see a lot of pulmonary nodules here in TN.
This is a man in his late 60s with severe COPD (FEV1~40%) who had some nodules on his CxR. He had a CT scan done and has 2 main nodules on the right (pictured) and a very small one (not pictured) on the left. His bronch was non-diagnostic and his PET was negative. Would you pursue this any further or just watch?

4 comments - CLICK HERE to read & add your own!:

Arenberg said...

I can't see if they are calcified or not, but I'll assume they aren't or we wouldn't be talking about this. If they are PEt negative, it is veery reasonable to follow them. What is controversial is for how long, and how often. The ACCP will be revising its evidence based guidelines this summer, and they will be published next January or so, but they will probably allow for biopsy or following serially in this situation.

If you choose to bx, the RLL one looks "do-able" by CT, and that may be the best option of the patient is anxious.

If you choose CT, I'd wait three months, then @ 6, 12, & 24 if it remains stable.

Jennings said...

Doug, you are saying that you would get a biopsy of a solitary pulmonary nodule? In operable patients, I thought the 2 options would be watching with serial CT's or resection. What is the utility of a needle biopsy? If it is positive you resect and if it is negative it doesn't really rule out cancer so you resect anyway.

Baleeiro said...

Actually that solitary nodule has some company...

Arenberg said...

"Doug, you are saying that you would get a biopsy of a solitary pulmonary nodule? In operable patients, I thought the 2 options would be watching with serial CT's or resection"

In a case wherer the nodule is PET negative, and accessible to biopsy, this approach has been shown to be very cost effective (Gould, et al, Annalas of Internal Medicine ~March or May 2003, I forget which)