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Management of solitary pulmonary nodule

INVESTIGATION. INITIAL INVESTIGATION:Chest X-RAY CT SCAN Looking for:margin characteristics Calcification pattern Size Growth rate. Finding. patterns of the margins:corona radiata sign and speculation: relatively specific for cancer.A scalloped border: intermediate probability of cancer

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Management of solitary pulmonary nodule

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    1. Management of solitary pulmonary nodule Done by:alia’a hassan Dr: shadi hamouri

    2. INVESTIGATION INITIAL INVESTIGATION: Chest X-RAY CT SCAN Looking for: margin characteristics Calcification pattern Size Growth rate

    3. Finding patterns of the margins: corona radiata sign and speculation: relatively specific for cancer. A scalloped border: intermediate probability of cancer. smooth border: more suggestive of a benign diagnosis

    4. non–small-cell lung cancer nodule with a corona radiata. Multiple fine striations extend perpendicularly to the surface of the nodule, which is surrounded by a radiolucent halo formed by emphysematous lung tissue.

    5. adenocarcinoma a spiculated lesion

    6. intermediate probability of cancer a lesion with a scalloped border. 

    7. Calcification within a nodule: suggests that it is a benign lesion. A laminated or central pattern: is typical of a granuloma classic “popcorn” pattern: is most often seen in hamartomas. Calcification patterns that :are stippled or eccentric have been associated with cancer.

    8. histoplasmoma a smooth, well-marginated nodule in the left lung with dense central calcification

    9. hamartoma a well-demarcated lesion with both calcification and fat

    10. The growth rate of a nodule can be estimated if previous images are available to allow accurate measurement of changes in its size. We measure The volume doubling time. If lesions are considered spherical, a 30 percent increase in diameter represents a doubling of volume. nodule that was not present on a radiograph obtained less than two months before the current image is therefore not likely to be malignant

    11. stability of findings on chest radiographs for two years has been considered a sign that a lesion is benign, although bronchoalveolarcell carcinomas and typical carcinoids occasionally appear to be stable for two or more years.

    12. Follow up three-month intervals during the first year after a nodule is discovered and then at six-month intervals during the next year. With high-resolution CT is used.

    13. nonsurgical approaches to diagnosis CT Densitometry: CT densitometry involves the measurement of attenuation values, expressed in Hounsfield units . Attenuation values are usually higher for benign nodules than they are for malignant nodule. the cutoff point used was 264 Hounsfield units; lesions with greater density were considered to be benign.

    14. Contrast-Enhanced CT: the degree of enhancement on spiral CT after the injection of intravenous contrast material is used to differentiate benign from malignant lesion High sensitivity. Bronchoscopy: The sensitivity of bronchoscopy for detecting a malignant process in a solitary pulmonary nodule ranges from 20 to 80 percent, depending on the size of the nodule and its proximity to the bronchial tree , and the prevalence of cancer in the study population.

    15. Transthoracic Fine-Needle aspiration Biopsy : Transthoracic fine-needle aspiration biopsy identifies peripheral pulmonary lesions as malignant or benign in up to 95 percent of cases. positron-emission tomography: In PET, the uptake of fludeoxyglucose F 18 is used to measure glucose metabolism. Because of increased metabolic activity, most lung tumors have greater uptake of fludeoxyglucose F 18 than normal Tissue. PET may also provide staging information.

    16. selecting a diagnostic strategy probability of cancer determines the most cost-effective strategy for the diagnosis of a solitary nodule. radiographic follow-Up: when the probability of cancer is low (<12 percent) CT and PET scanning :when the probability is intermediate (12 to 69 percent) CT followed by either biopsy or surgery : when the probability is high (>69 to 90 percent) surgery :when the probability is very high (>90 percent)

    18. thoracotomy Nearly all solitary nodules are resectable. Lobectomy in patients with malignant disease is associated with an operative mortality rate of 3 to 7 percent or less. Resection of benign nodules is associated with a mortality rate of less than 1 percent, because only a small wedge resection is required.

    19. video-assisted thoracoscopic surgery Video-assisted thoracoscopic surgery offers the potential for lower morbidity and a shorter hospital stay than conventional thoracotomy. Video-assisted thoracoscopic surgery may be most successful for the treatment of peripheral lesions and some central lesions in the lower lobe. As surgical morbidity and mortality decline, the strategy of proceeding directly to video-assisted thoracoscopic surgery becomes more effective than other diagnostic approaches.

    20. THANK YOU

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