Solitary Pulmonary Nodule

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Solitary Pulmonary Nodule
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Solitary Pulmonary Nodule

• Remember that exploratory incision should not
  be made a cloak for diagnostic incompetence
  Rutherford Morrison (1853-1939)

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Tissue characterization of SPNComparative study
between helical CT and integrated PET/CT

• Methods 119 Pt. with SPN-underwent both enhanced
  spiral CT and PET/CT scan
• On spiral CT, a nodule was considered malignant
  with enhancement of gt25 HU
• On PET/CT, nodules were considered malignant with
  Max. SUV gt3.5
• The sensitivity, specificity and accuracy were
  compared

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• Results There were 79 malignant 40 benign
  nodule
• Sensitivity, specificity and accuracy of enhanced
  CT were 81, 93 85
• Those on PET/CT were 96 e p0.008, 88 e p0.72
  accuracy 93 e p0.011
• Conclusion PET/CT may be performed as 1st line
  test for SPN
• JNM 200647(3)443-

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SOLITARY PULMONARY NODULE
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Solitary Pulmonary Nodule

• Action is not a substitute for judgment

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SOLITARY PULMONARY NODULE
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SOLITARY PULMONARY NODULE
Conclusions
There is no one way to manage the indeterminate
nodule, but the diagnosis require a suitable
clinical evaluation. The judicious application of
diagnostic methods that based on the medicine
evidence based, will improve the quality of the
medical attention.
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Excisional biopsy may be attractive for the
surgeon because it provides a definite diagnosis
and place the surgeon in a win position.
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SOLITARY PULMONARY NODULE
Conclusions
It is important to assess and respect the
patients anxiety and fears. Most importantly,
surgeons must personally oversee the follow-up
and be willing to change their opinion, as new
evidence is available.
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It is my bias that these nodules are best managed
by thoracic surgeons who must have confidence
that the algorithm followed in observing some
patients, will not alter the ultimate outcome,
even if the nodule should subsequently prove
malignant.
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THANK YOU!