PULMONARY NEOPLASMS QUESTIONS AND ANSWERS A+
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What is a solitary pulmonary nodule?
"coin lesion"
<3 cm isolated, rounded opacity on chest imaging outlined by a normal lung
Solitary pulmonary nodules are not associated with?
infiltrate, atelectasis, or adenopathy
Majority of solitary pulmonary nodules are __________ and are a ________
finding on chest imaging
asymptomatic
incidental finding
- important b/c nodules carry significant risk of malignancy
What is the goal when it comes to pulmonary nodules?
resect malignant tumors
avoid invasive procedures in benign disease
What are 2 general risk factors for malignancy of a pulmonary nodule?
age and lifestyle
Who is at a decreased risk of a malignant pulmonary nodule?
<30 y/o
Who is at an increased risk of a malignant pulmonary nodule?
smokers (pack per year hx)
prior malignancy
Define pack year
20 cigarettes smoked everyday for one year
Ex: There are 20-25 cigarettes per pack. If someone smokes 10 cigarettes per day x 2
years --> 1 pack year
What is the 1st step to determine if a pulmonary nodule is malignant?
review old imaging studies to estimate doubling time
A doubling time of <30 days suggests?
A doubling time of >465 days suggests?
A doubling time in between the 2 above suggests?
<30 days --> infection
>465 days --> long-term stability and benign status
in between --> concern for malignancy
What is the 2nd step to determine if a pulmonary nodule is malignant?
, evaluate nodule in current imaging including the:
- size
- shape and appearance
What is the malignancy rate for the following sized nodules?
2-5 mm
6-10 mm
11-20 mm
21-45 mm
2-5 mm --> 1%
6-10 mm --> 24%
11-20 mm --> 33%
21-45 mm --> 80%
What is the shape and appearance of a lower risk pulmonary nodule?
smooth, well-defined edge
dense calcification in a central or laminated pattern
What is the shape and appearance of a higher risk pulmonary nodule? (4)
lobule shape or ill-defined edge
spiculated margins (spikes coming off of it) or peripheral halo
cavitary lesions with thick >16 mm walls
sparser calcification that is stippled (multiple calcified specks) or eccentric (single small
calcification)
Which type of calcification is more worrisome: stippled or eccentric?
eccentric
What type of imaging should be done on all pts with a nodule and why?
Chest CT --> helps better define nodule characteristics
Who decided whether the nodule will need a biopsy or surgery and how is it
decided?
oncologist
based on probability of malignancy
What is done for nodules with low probability of malignancy (<5%)?
watchful waiting
imaging studies at regular intervals to monitor (every 6 months to a year)
What is done for a <6mm solid nodule without risk factors for malignancy?
do not require follow up
What is done for a pulmonary nodule with an intermediate probability of
malignancy (5-60%)?
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What is a solitary pulmonary nodule?
"coin lesion"
<3 cm isolated, rounded opacity on chest imaging outlined by a normal lung
Solitary pulmonary nodules are not associated with?
infiltrate, atelectasis, or adenopathy
Majority of solitary pulmonary nodules are __________ and are a ________
finding on chest imaging
asymptomatic
incidental finding
- important b/c nodules carry significant risk of malignancy
What is the goal when it comes to pulmonary nodules?
resect malignant tumors
avoid invasive procedures in benign disease
What are 2 general risk factors for malignancy of a pulmonary nodule?
age and lifestyle
Who is at a decreased risk of a malignant pulmonary nodule?
<30 y/o
Who is at an increased risk of a malignant pulmonary nodule?
smokers (pack per year hx)
prior malignancy
Define pack year
20 cigarettes smoked everyday for one year
Ex: There are 20-25 cigarettes per pack. If someone smokes 10 cigarettes per day x 2
years --> 1 pack year
What is the 1st step to determine if a pulmonary nodule is malignant?
review old imaging studies to estimate doubling time
A doubling time of <30 days suggests?
A doubling time of >465 days suggests?
A doubling time in between the 2 above suggests?
<30 days --> infection
>465 days --> long-term stability and benign status
in between --> concern for malignancy
What is the 2nd step to determine if a pulmonary nodule is malignant?
, evaluate nodule in current imaging including the:
- size
- shape and appearance
What is the malignancy rate for the following sized nodules?
2-5 mm
6-10 mm
11-20 mm
21-45 mm
2-5 mm --> 1%
6-10 mm --> 24%
11-20 mm --> 33%
21-45 mm --> 80%
What is the shape and appearance of a lower risk pulmonary nodule?
smooth, well-defined edge
dense calcification in a central or laminated pattern
What is the shape and appearance of a higher risk pulmonary nodule? (4)
lobule shape or ill-defined edge
spiculated margins (spikes coming off of it) or peripheral halo
cavitary lesions with thick >16 mm walls
sparser calcification that is stippled (multiple calcified specks) or eccentric (single small
calcification)
Which type of calcification is more worrisome: stippled or eccentric?
eccentric
What type of imaging should be done on all pts with a nodule and why?
Chest CT --> helps better define nodule characteristics
Who decided whether the nodule will need a biopsy or surgery and how is it
decided?
oncologist
based on probability of malignancy
What is done for nodules with low probability of malignancy (<5%)?
watchful waiting
imaging studies at regular intervals to monitor (every 6 months to a year)
What is done for a <6mm solid nodule without risk factors for malignancy?
do not require follow up
What is done for a pulmonary nodule with an intermediate probability of
malignancy (5-60%)?
