Crabtree

1. 60 y.o. male factory worker underwent a routine chest X-ray during a scheduled work physical. This chest X-ray and subsequent CT scan revealed a 2.5 cm spiculated right upper lobe peripheral nodule. He is currently still smoking. He is active and walks 2 miles/day. His FEV1% is 80% of predicted and his DLCO% is 70% of predicted. He has normal cardiac function and had a negative stress test. PET/CT and CT scan revealed no evidence of distant or nodal disease. CT-guided biopsy reveals non-small cell lung cancer.

2. Crabtree

3. A 62 y.o. female was in a minor car accident with no resulting injuries. During her evaluation in the ED, a CT scan revealed a 2.2 cm peripheral mass in the left upper lobe. She is a previous smoker but quit 5 years ago. PET/CT demonstrated no evidence of nodal or distant disease. She walks her dog 1 mile/day with some effort. Her FEV1% predicted is 52% and her DLCO% predicted is 55%. She had a negative stress test. Biopsy of the mass revealed non-small cell lung cancer.

4. Crabtree

5. A 59 y.o. male smoker was treated for bronchitis with a 10 day course of antibiotics. His symptoms of cough resolved with the antibiotics but a chest x-ray performed during his work-up revealed a 2 cm peripheral right lower lobe mass. CT scan confirmed the 2 cm mass in the periphery of the right lower lobe with PET/CT and CT demonstrating no evidence of nodal or distant disease. He walks less than a block per day. He had a non-Q wave MI 2 years ago and is on Plavix. By ECHO, his EF is 35%. His FEV1 is 52% of predicted and his DLCO is 55% of predicted.

6. Crabtree

7. A 61 y.o. male underwent cardiac evaluation for atypical chest pain. He ultimately had a cardiac catheterization that was normal with good LV function. His pain resolved with proton pump inhibitors. A pre-cath chest x-ray revealed a 2.6 cm right upper lobe lung nodule. He quit smoking 3 years ago. He gets short of breath walking up one flight of stairs. His FEV1 is 45% of predicted and his DLCO is 45% of predicted. CT and PET/CT revealed no evidence of nodal or distant disease.

8. Crabtree

9. Second Vote for Question 8 Crabtree

10. A 57 y.o. male presents to the ED with exacerbation of his COPD with shortness of breath. His symptoms improve with bronchodilators, oxygen, and a short course of steroids. Chest x-ray reveals a 1.9 cm mass in the left lower lobe. CT scan confirms the presence of a peripheral 1.9 cm spiculated mass in the left lower lobe with calcified mediastinal lymph nodes. PET/CT is negative for nodal or distant disease. CT-guided biopsy confirms non small cell lung cancer. He recently had a negative DP thallium stress test and normal LV function on ECHO. His FEV1 is 30% of predicted and his DLCO is 25% of predicted. What treatment would you recommend for this patient?

11. Crabtree

12. An 80 y.o. female retired nurse had a screening CT scan as part of a clinical study that revealed a 2.6 cm left lower lobe mass in the periphery of the superior segment. She is a previous smoker but quit 10 years ago. PET/CT and CT revealed calcified lymph nodes but no evidence of nodal or metastatic disease. CT-guided biopsy revealed non small cell lung cancer. She does her own shopping but is unable to walk a flight of stairs without becoming short of breath. Stress test was negative and ECHO revealed good LV function. Her FEV1 was 46% predicted and her DLCO was 55% predicted. What treatment would you recommend for this patient?

13. Crabtree

14. An 82 y.o. retired colonel from the army fell off a ladder while working on the house. He had no major injuries but a chest x-ray revealed a 1.9 cm mass in the right lower lobe. Subsequent chest CT scan confirmed a 1.9 cm mass in the periphery of the right lower lobe. He quit smoking 5 years ago. Recent cardiac workup revealed normal LV function and no significant coronary disease by catheterization after a stress test was read as slightly abnormal. He has to take more frequent breaks when working around the house because he gets tired. His FEV1 is 57% of predicted and his DLCO is 55% of predicted. PET/CT revealed no evidence of nodal or distant disease. CT-guided biopsy revealed non small cell lung cancer.

15. Crabtree

16. An 80 y.o. female retired nurse had a screening CT scan as part of a clinical study that revealed a 2.6 cm left lower lobe mass in the periphery of the superior segment. She is a previous smoker but quit 10 years ago. PET/CT and CT revealed calcified lymph nodes but no evidence of nodal or metastatic disease. CT-guided biopsy revealed non small cell lung cancer. She does her own shopping but is unable to walk a flight of stairs without becoming short of breath. Stress test was negative and ECHO revealed good LV function. Her FEV1 was 46% predicted and her DLCO was 55% predicted.

17. Crabtree

18. A 79 y.o. retired male underwent coronary stenting 1.5 years ago for coronary artery disease. At the time of stenting he was noted to have a 1 cm peripheral mass in the RUL. This was followed, and on the most recent CT scan the mass had increased in size to 1.5 cm and is irregular. CT-guided biopsy revealed non small cell lung cancer. PET/CT is negative for nodal or distant disease. He gets short of breath after walking ½ mile with the dog. On recent ECHO, his EF was 25%. His FEV1 is 57% predicted and his DLCO is 60% of predicted.

19. Crabtree

20. Crabtree

21. Crabtree

22. An oxygen dependent 78 yo female with endstage COPD (FEV1 38% predicted) is found to have a peripheral 1.5 cm L upper lobe nodule which proves to be an adenocarcinoma on FNA. CT and PET scanning suggest no nodal or distant metastases. Naunheim

23. Surveillance screening identifies a PET positive (SUV 6) 8mm nodule centrally located in the R upper lobe which is subsequently diagnosed as squamous cancer using navigational bronchoscopy. CT and PET scans suggest no nodal or distant metastases and PFTs are near normal. Naunheim

24. Naunheim

25. Naunheim

26. Yasufuku

27. Yasufuku

28. Yasufuku

29. Yasufuku

30. Luketich

31. Luketich