Pulmonary Nodule

The challenge presented by a pulmonary nodule has faced physicians and patients since the advent of the chest x-ray. Is the nodule cancer (malignant) or not (benign)? What and when should something be done about it? Know that the majority of pulmonary nodules (especially if solitary) are benign; however, the detection of a nodule may be the first and only point in time of a chance for cure in the patient with lung cancer.

CAT (or more appropriately Computerized Tomography, CT) is recognized as the most sensitive imaging method for detecting pulmonary nodules. The development of low-dose, fast spiral CT has greatly reduced the radiation dose and scan time. Your PCCS physician’s evaluation of any abnormal chest x-ray or CT finding will be greatly enhanced by comparing current images with prior x-rays. In fact, this is the single most important piece of information that you can give your PCCS physician. By knowing that an area of abnormality of chest x-ray or CT has remained unchanged for greater than 2 years, one can be virtually guaranteed that such an abnormality is benign.

Despite the sensitivity of CT regarding the detection of pulmonary nodules, CT still does not tell a physician whether said finding is an active process or inactive (benign). The advent of positron emission tomography (PET) scanning has greatly enhanced our ability to evaluate these nodules. PET scanning involves the injection of a radioactive form of glucose (sugar-water). The amount of radiation is comparable to CT. However, unlike CT, those areas of the lung having increased metabolic activity such as tumors or active infection incorporate the radioactive sugar during the scan and the abnormality “lights up”. Depending on the degree of enhancement, the radiologist can comment on the likelihood of malignancy.

Although PET greatly increases our suspicion of whether an abnormality is benign or malignant, ultimately, a tissue biopsy may be warranted. This can be obtained in a variety of ways, from least invasive to more invasive. The use of bronchoscopy, a scope for the lung, allows your PCCS physician to inspect, wash and even obtain a small piece of lung tissue without requiring admission to the hospital or general anesthesia. Unfortunately, the yield from such a relatively non-invasive procedure is not 100% and in fact, the diagnostic yield (finding out what the nodule truly is) only occurs in 10-20% of biopsies if the area is small, <2cm in size (about 1 inch). In cases where a malignant process is still suspected, your PCCS physician may refer you to a chest surgeon for a surgical biopsy.

The important thing to remember is having found the area early, the chances for a good outcome are much improved and many options are available regarding the speed and aggressiveness by which an answer can be pursued.