Type:
Educational Exhibit
Keywords:
Hybrid Imaging, Lung, Oncology, Digital radiography, CT, PET-CT, Biopsy, Staging, Radiation therapy / Oncology, Cancer, Pathology, Metastases
Authors:
S. M. I. Y. Shalaby1, W. Shawaf2, M. Keshk2, M. Abd El Samee2, M. Adel Shanah2, S. Fateh2, M. Gamal2; 1Cairo, Ca/EG, 2Cairo/EG
DOI:
10.26044/ecr2019/C-1427
Background
Solitary pulmonary nodules (SPNs) refer to round or oval lung lesions,
with clear margins,
not more than 30 mm in diameter,
surrounded by healthy normal lung parenchyma,
and not associated with satellite lesions,
atelectasis,
pneumonia or hilar enlargement,
neither concurrent mediastinal lymphadenopathy.[1]
Although most SPNs are benign,
about 35% are primary malignancies [2],
with majority of those SPNs are in TNM stage IA,
with a 5-year survival rate for patients of 61% to 75% [3].
Because of the small lesion volume and the lack of specific CT imaging features between benign and malignant lesions,
estimating the probability of malignancy is a common problem [4].
Additionally,
as it is difficult to identify SPNs,
about half of patients with lung cancer miss the optimal timing of surgery,
resulting in a 10% to 15% decreased 5-year survival rate [5].
Thus,
improving the accuracy of SPNs diagnosis is therefore critical to the treatment options and prognosis for patients.
Despite detailed CT studies,
many (SPN) are still classified as indeterminate nodules.
Those indeterminate nodules require further evaluation with a histological tissue sampling.
If the clinical and radiological features are reassuring,
a watch-and-wait policy may be taken,
with regular scanning to assess any interval change.
Yet,
there has been a wide variation in the sensitivity and specificity of both bronchoscopy and transthoracic needle biopsy in the detection of malignancy in these indeterminate cases.[6]