JAMA: At least 95% of lung nodules are benign

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JAMA: At least 95% of lung nodules are benign

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JAMA: At least 95% of lung nodules are benign

Importance:

Pulmonary nodules are found in approximately 1.6 million patients each year in the United States, and can be detected in approximately 30% of chest computed tomography (CT) images.

Optimal treatment of individuals with lung nodules allows early detection of cancer while minimizing detection of benign nodules.

Observations:

At least 95% of pulmonary nodules are benign, most commonly granulomas or intrapulmonary lymph nodes. Smaller nodules are more likely to be benign. Lung nodules were classified as small solid (<8 mm), large solid (≥8 mm), and subsolid .

Subsolid nodules are divided into ground glass nodules (no solid component) and partially solid (both ground glass and solid components).

All nodules smaller than 6 mm have a less than 1% chance of malignancy, and 1% to 2% for nodules between 6 mm and 8 mm .

Nodules 6 to 8 mm can be repeated with chest CT in 6 to 12 months, depending on the presence of risk factors and imaging features associated with lung malignancy, clinical judgment of the probability of malignancy, and patient preference.

Treatment of individuals with solid pulmonary nodules 8 mm or larger is based on estimated probability of malignancy; presence of patient comorbidities, such as chronic obstructive pulmonary disease and coronary artery disease; and patient preference.

Management options include surveillance imaging, defined as monitoring of nodule growth by chest CT imaging, PET-CT imaging, nonsurgical biopsy using bronchoscopy or transthoracic needle biopsy, and surgical resection.

Partial solid pulmonary nodules are managed according to the size of the solid component. A larger solid fraction is associated with a higher risk of malignancy .

When ground-glass pulmonary nodules persist for more than 3 months and are larger than 10 mm in diameter, the probability of malignancy ranges from 10% to 50%.

Malignant nodules with a completely ground glass appearance usually grow slowly. Current bronchoscopy and transthoracic needle biopsy methods have a sensitivity of 70% to 90% for the diagnosis of lung cancer.

Conclusions and relevance:

Pulmonary nodules are found in approximately 1.6 million people in the United States each year, accounting for approximately 30% of chest CT images.

Treatment of patients with pulmonary nodules should be guided by the likelihood that the nodule is malignant, the safety of testing, the likelihood that additional testing will be informative, and patient preference.

JAMA: At least 95% of lung nodules are benign

(source:internet, reference only)

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