Diagnostic Dilemma

Diagnostic Dilemma

Is it lung cancer?

Once a nodule is found, determining how to proceed is challenging.

  • Should I do something?
  • Can I do anything?
  • What are the potential consequences?
  • What is the risk-benefit?
  • What will I do based on the results?

Managing pulmonary nodules in the 8-30 mm size range involves a wide of array of diagnostic options and evaluation of risk factors.

In this size range, most nodules are benign, but determining which are benign or malignant without invasive procedures is challenging with current diagnostic tools.

Current diagnostic procedures have limitations and risk(1)

PET
False Positive 12.5-20.6%
False Negative 3.8-28.3%
Nodule Size Limit >10mm
Bronchoscopy
False Negatives 30-70%
Bleeding 2-5%
Pneumothorax 2-4%
FNA
False Negatives 10-30%
Non-Diagnostic 1-55% (med.6%)
Pneumothorax 15%
Pneumothorax - Chest Tube 6-7%
Surgery
False Positives 18-34%
Persistent Air Leak 3-5%
Pneumonia 1-8%
Death 0.5%


References:
1. Gould et al. Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer? Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2013; 143(5)(Suppl):e93S–e120S

 
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