Diagnosis of solitary pulmonary nodules and patients follow-up strategy

Abstract

Solitary pulmonary nodule is the common clinical problem. Following the detection of solitary nodules practitioner first face the question of the probability of malignancy and the future strategy and tactics of the patient management. The report highlights the issues of differential diagnosis of solitary nodules and modern standards of management of these patients, including issues of their follow-up care. The importance of a multidisciplinary approach to this problem is emphasized. Strategy for the management of patients with solitary nodules include: (1) the computed tomography performance, its comparing with previous data; (2) an assessment of the margin, size, calcification type, solitary nodule type (solid, subsolid); (3) the risk of malignancy assessment. Further actions can be performed according to algorithms: nodule ≤8 mm; nodule >8 mm. According to screening tests for the early detection of lung cancer in smokers at high risk for development of malignant tumors, solitary nodules are found in 50% of cases. When choosing a strategy it is necessary to inform the patient about all the positives and negatives of follow-up care by means of computed tomography. Its main goal is to secure patient with benign nodules against unwanted invasive procedures, especially if there is no need for treatment. This advantage is put on one side of the scale, and on the second - the risk of delayed diagnosis of cancer, and excessive exposure to radiation. In light of the above all the patients with solitary nodules of undefined etiology should be referred to a specialized pulmonary center for multidisciplinary experts evaluating - pulmonologists, thoracic surgeons, pathologists and radiology specialists, which allows to develop the most optimal strategy for these patients.