The solitary pulmonary nodule.pdf

The solitary pulmonary nodule A.W.K. Tang, H.A. Moss, R.J.H. Robertson
Department of Radiology, Leeds Teaching Hospitals, Leeds, UK Received 17 September 2002; received in revised form 18 September 2002; accepted 19 September 2002 Abstract The solitary pulmonary nodule will be found increasingly by the use of newer imaging techniques, including computed tomography (CT) screening. The aim must be to have an approach that avoids unnecessary surgery or biopsy with their attendant risks. Plain films characterisation, CT assessment, including densitometry and enhancement, and growth patterns are discussed and evaluated. The use of Bayes theorem to guide these assessment strategies is also described. # 2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Solitary pulmonary nodule; Nodule characterisation; CT densitometry; CT nodule enhancement; Nodule growth patterns; Bayes theorem 1. Introduction The discovery of a Solitary Pulmonary Nodule (SPN) is a common occurrence on chest radiographs (CXR) and continues to represent a diagnostic challenge as a significant minority of these represent early lung cancer. In mass screening studies, from 0.09 to 0.2% of CXR have revealed SPN [1,2]. With the advent of widely available CT scanning, the discovery of SPN is set to escalate (Fig. 1). Two recent lung cancer screening studies suggest that 23/51% of smokers over 50 will have at least one SPN [3,4]. Lung cancer is the leading cause of cancer mortality in Europe and in 1995 accounted for 330 000 deaths. It is the commonest cause of cancer deaths in men and the third commonest in women behind breast and colorectal cancer [5]. These figures differ significantly from the U.S. where mortality from lung cancer predominates in both sexes [6]. European 5-year survival rates of 10% are appalling [7]. However, survival following resection improves dramatically for stage IA tumours (T1N0M0). In primary lesions smaller than 3 cm with no nodal spread, 5-year survival approach