Skip to main content
SpringerLink
Log in

23 Imaging of the Solitary Pulmonary Nodule

  • Chapter
  • First Online:
Evidence-Based Imaging

  • 1165 Accesses

Key Points

Further evaluation of a solitary pulmonary nodule (SPN) incidentally detected on chest radiography is not needed when either of the following two criteria (moderate evidence) is met: Nodule is stable in size for at least 2 years when compared to prior chest radiographs; there is a benign pattern of calcification demonstrated on chest radiography. Further evaluation of a pulmonary nodule showing a benign pattern of calcification, fat, or stability for 2 years or more on thin-section computed tomography (CT) is not needed (moderate evidence). In the absence of benign calcification, fat, or documented radiographic stability for at least 2 years, the choice of subsequent imaging strategy to differentiate between benign and malignant nodules is critically dependent on the pretest probability of malignancy. CT should be the initial test for most patients with radiographically indeterminate pulmonary nodules (moderate evidence). 18-Fluorodeoxyglucose positron emission tomography (18FDG-PET) has a high sensitivity and specificity for malignancy (strong evidence), and is most cost-effective when used selectively in patients where the CT findings and pretest probability of malignancy are discordant. The use of multidetector CT (MDCT) scanners with improved spatial resolution for lung cancer screening has led to the increased detection of small (<1 cm) pulmonary nodules. Nodules are categorized on CT as (1) solid, (2) part-solid (mixed solid and ground-glass attenuation), or (3) nonsolid (pure ground-glass attenuation). The imaging strategy for the further evaluation of small solid pulmonary nodules in the absence of a known primary malignancy is based on nodule diameter (moderate evidence). For solid nodules 4–10 mm in diameter, a strategy of careful observation with serial thin-section CT scanning is recommended at 6, 12, and 24 months. In patients with a known primary neoplasm, initial reevaluation at 3 months is recommended. For solid nodules larger than 10 mm in diameter, further evaluation with 18FDG-PET, percutaneous needle biopsy, or video-assisted thoracoscopic surgery (VATS) is recommended. Part-solid nodules (solid and ground-glass components) and nonsolid nodules (pure ground glass) detected at lung cancer screening have a higher likelihood of malignancy than solid nodules; therefore, tissue sampling (percutaneous CT-guided biopsy or VATS) is recommended (moderate evidence). For nodules less than 1 cm where this may not be possible, close serial CT evaluation at 3-month intervals in recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Tuddenham WJ. AJR Am J Roentgenol 1984;143:509–517.

    PubMed  CAS  Google Scholar 

  2. Earnest F, Ryu JH, Miller GM et al. Radiology 1999;211:137.

    PubMed  Google Scholar 

  3. Holin SM, Dwork RE, Glaser S, Rikli AE, Stocklen JB. Am Rev Tuberc 1959;79:427–439.

    PubMed  CAS  Google Scholar 

  4. Swensen SJ, Jett JR, Sloan JA et al. Am J Respir Crit Care Med 2002;165:508–513.

    PubMed  Google Scholar 

  5. Henschke CI, McCauley DI, Yankelevitz DF et al. Lancet 1999;354:99–105.

    Article  PubMed  CAS  Google Scholar 

  6. Comstock GW, Vaughan RH, Montgomery G. N Engl J Med 1956;254:1018–1022.

    Article  PubMed  CAS  Google Scholar 

  7. Stelle JD. J Thorac Cardiovasc Surg 1963;46:21–39.

    Google Scholar 

  8. Siegelman SS, Khouri NF, Leo FP, Fishman EK, Braverman RM, Zerhouni EA. Radiology 1986;160:307–312.

    PubMed  CAS  Google Scholar 

  9. Zerhouni EA, Stitik FP, Siegelman SS et al. Radiology 1986;160:319–327.

    PubMed  CAS  Google Scholar 

  10. Kaneko M, Eguchi K, Ohmatsu H et al. Radiology 1996;201:798–802.

    PubMed  CAS  Google Scholar 

  11. Steele JD. J Thorac Cardiovasc Surg 1963;46:21–39.

    PubMed  CAS  Google Scholar 

  12. Yankelevitz DF. Semin Ultrasound CT MR 2000;21:95–96.

    Article  PubMed  CAS  Google Scholar 

  13. Gurney JW, Lyddon DM, McKay JA. Radiology 1993;186:415–422.

    PubMed  CAS  Google Scholar 

  14. Bateson EM. Clin Radiol 1965;16:51–65.

    Article  PubMed  CAS  Google Scholar 

  15. Ray JFD, Lawton BR, Magnin GE et al. Chest 1976;70:332–336.

    Article  PubMed  Google Scholar 

  16. Higgins GA, Shields TW, Keehn RJ. Arch Surg 1975;110:570–575.

    PubMed  CAS  Google Scholar 

  17. Yankelevitz DF, Henschke CI. Am J Roentgenol 1997;168:325–328.

    CAS  Google Scholar 

  18. Good CA, Wilson TW. The solitary circumscribed pulmonary nodule; study of seven hundred five cases encountered roentgenologically in a period of three and one-half years. J Am Med Assoc 1958;166(3):210–215.

    PubMed  CAS  Google Scholar 

  19. Collins VP, Loeffler RK, Tivey H. Am J Roentgenol 1956;76:988–1000.

    CAS  Google Scholar 

  20. Brues AM WA, Andervant HB. Proc Soc Exp Biol Med 1939;43:375–377.

    Google Scholar 

  21. Mottram J. J Pathol 1935;40:407–414.

    Article  Google Scholar 

  22. Nathan MH, Collins VP, Adams RA. Radiology 1962;79:221–232.

    PubMed  CAS  Google Scholar 

  23. Steele JD, Buell P. J Thorac Cardiovasc Surg 1973;65:140–151.

    PubMed  CAS  Google Scholar 

  24. Geddes DM. Br J Dis Chest 1979;73:1–17.

    Article  PubMed  CAS  Google Scholar 

  25. Weiss W. Am Rev Respir Dis 1971;103:198–208.

    PubMed  CAS  Google Scholar 

  26. Lillington GA. Dis Mon 1991;37:271–318.

    PubMed  CAS  Google Scholar 

  27. Wormanns D, Diederich S, Lentschig MG, Winter F, Heindel W. Eur Radiol 2000;10:710–713.

    Article  PubMed  CAS  Google Scholar 

  28. Winer-Muram HT, Jennings SG, Tarver RD et al. Radiology 2002;223:798–805.

    Article  PubMed  Google Scholar 

  29. Henschke CI, Yankelevitz D, Westcott J et al. ACR appropriateness criteria. Radiology 2000;215S:607–609.

    Google Scholar 

  30. Yankelevitz DF, Reeves AP, Kostis WJ, Zhao B, Henschke CI. Radiology 2000;217:251–256.

    PubMed  CAS  Google Scholar 

  31. Aoki T, Nakata H, Watanabe H et al. Am J Roentgenol 2000;174:763–768.

    CAS  Google Scholar 

  32. Good CA, Hood RT Jr, Mc D Jr. Am J Roentgenol 1953;70:543–554.

    CAS  Google Scholar 

  33. O’Keefe ME, Good CA, McDonald JR. Am J Roentgenol 1957;77:1023–1033.

    Google Scholar 

  34. Bateson EM, Abbott EK. Clin Radiol 1960;11:232–247.

    Article  PubMed  CAS  Google Scholar 

  35. Stewart JG, MacMahon H, Vyborny CJ, Pollak ER. Am J Roentgenol 1987;148:29–30.

    CAS  Google Scholar 

  36. Mahoney MC, Shipley RT, Corcoran HL, Dickson BA. Am J Roentgenol 1990;154:255–258.

    CAS  Google Scholar 

  37. Berger WG, Erly WK, Krupinski EA, Standen JR, Stern RG. Am J Roentgenol 2001;176:201–204.

    CAS  Google Scholar 

  38. Proto AV, Thomas SR. Radiology 1985;156:149–153.

    PubMed  CAS  Google Scholar 

  39. Zerhouni EA, Boukadoum M, Siddiky MA et al. Radiology 1983;149:767–773.

    PubMed  CAS  Google Scholar 

  40. Siegelman SS, Khouri NF, Scott WW Jr et al. Radiology 1986;160:313–317.

    PubMed  CAS  Google Scholar 

  41. Remy J, Remy-Jardin M, Wattinne L, Deffontaines C. Radiology 1992;182:809–816.

    PubMed  CAS  Google Scholar 

  42. Hillerdal G. Chest 1989;95(4):313–317.

    Article  Google Scholar 

  43. Westcott JH, Volpe JP. Radiology 1991;181(P):182.

    Google Scholar 

  44. Rose RW, Ward BH. Radiology 1973;106:179–182.

    PubMed  CAS  Google Scholar 

  45. Eggli KD. Radiol Clin North Am 1993;31:651–666.

    PubMed  CAS  Google Scholar 

  46. Khan A, Herman PG, Vorwerk P, Stevens P, Rojas KA, Graver M. Radiology 1991;179:477–481.

    PubMed  CAS  Google Scholar 

  47. Takanashi N, Nobe Y, Asoh H, Yano T, Ichinose Y. Lung Cancer 1995;13:105–112.

    Article  PubMed  CAS  Google Scholar 

  48. Seemann MD, Staebler A, Beinert T et al. Eur Radiol 1999;9:409–417.

    Article  PubMed  CAS  Google Scholar 

  49. Seemann MD, Seemann O, Luboldt W et al. Lung Cancer 2000;29:105–124.

    Article  PubMed  CAS  Google Scholar 

  50. Swensen SJ, Viggiano RW, Midthun DE et al. Radiology 2000;214:73–80.

    PubMed  CAS  Google Scholar 

  51. Potente G, Iacari V, Caimi M. Comput Med Imaging Graph 1997;21:39–46.

    Article  PubMed  CAS  Google Scholar 

  52. Yamashita K, Matsunobe S, Takahashi R et al. Radiology 1995;196:401–408.

    PubMed  CAS  Google Scholar 

  53. Bhalla M, Shepard JA, Nakamura K, Kazerooni EA. J Comput Assist Tomogr 1995;19:44–47.

    Article  PubMed  CAS  Google Scholar 

  54. Higashi Y, Nakamura H, Matsumoto T, Nakanishi T. J Thorac Imaging 1994;9:31–34.

    PubMed  CAS  Google Scholar 

  55. Swensen SJ, Yamashita K, McCollough CH et al. Radiology 2000;214:81–85.

    PubMed  CAS  Google Scholar 

  56. Lowe VJ, Fletcher JW, Gobar L et al. J Clin Oncol 1998;16:1075–1084.

    PubMed  CAS  Google Scholar 

  57. Abe Y, Matsuzawa T, Fujiwara T et al. Int J Radiat Oncol Biol Phys 1990;19:1005–1010.

    Article  PubMed  CAS  Google Scholar 

  58. Gupta NC, Frank AR, Dewan NA et al. Radiology 1992;184:441–444.

    PubMed  CAS  Google Scholar 

  59. Dewan NA, Gupta NC, Redepenning LS, Phalen JJ, Frick MP. Chest 1993;104:997–1002.

    Article  PubMed  CAS  Google Scholar 

  60. Patz EF Jr, Lowe VJ, Hoffman JM et al. Radiology 1993;188:487–490.

    PubMed  Google Scholar 

  61. Dewan NA, Reeb SD, Gupta NC, Gobar LS, Scott WJ. Chest 1995;108:441–446.

    Article  PubMed  CAS  Google Scholar 

  62. Duhaylongsod FG, Lowe VJ, Patz EF Jr, Vaughn AL, Coleman RE, Wolfe WG. J Thorac Cardiovasc Surg 1995;110:130–139; discussion 139–140.

    Article  PubMed  CAS  Google Scholar 

  63. Duhaylongsod FG, Lowe VJ, Patz EF Jr, Vaughn AL, Coleman RE, Wolfe WG. Ann Thorac Surg 1995;60:1348–1352.

    Article  PubMed  CAS  Google Scholar 

  64. Gupta NC, Maloof J, Gunel E. J Nucl Med 1996;37:943–948.

    PubMed  CAS  Google Scholar 

  65. Dewan NA, Shehan CJ, Reeb SD, Gobar LS, Scott WJ, Ryschon K. Chest 1997;112:416–422.

    Article  PubMed  CAS  Google Scholar 

  66. Gupta N, Gill H, Graeber G, Bishop H, Hurst J, Stephens T. Chest 1998;114:1105–1111.

    Article  PubMed  CAS  Google Scholar 

  67. Orino K, Kawamura M, Hatazawa J, Suzuki I, Sazawa Y. Jpn J Thorac Cardiovasc Surg 1998;46:1267–1274.

    PubMed  CAS  Google Scholar 

  68. Prauer HW, Weber WA, Romer W, Treumann T, Ziegler SI, Schwaiger M. Br J Surg 1998;85:1506–1511.

    Article  PubMed  CAS  Google Scholar 

  69. Kubota K, Matsuzawa T, Fujiwara T et al. J Nucl Med 1990;31:1927–1932.

    PubMed  CAS  Google Scholar 

  70. Erasmus JJ, McAdams HP, Patz EF Jr, Coleman RE, Ahuja V, Goodman PC. Am J Roentgenol 1998;170:1369–1373.

    CAS  Google Scholar 

  71. Higashi K, Ueda Y, Seki H et al. J Nucl Med 1998;39:1016–1020.

    PubMed  CAS  Google Scholar 

  72. Mastin ST, Drane WE, Harman EM, Fenton JJ, Quesenberry L. Chest 1999;115:1012–1017.

    Article  PubMed  CAS  Google Scholar 

  73. Higashi K, Nishikawa T, Seki H et al. J Nucl Med 1998;39:9–15.

    PubMed  CAS  Google Scholar 

  74. Blum J, Handmaker H, Lister-James J, Rinne N. Chest 2000;117:1232–1238.

    Article  PubMed  CAS  Google Scholar 

  75. Gambhir SS, Handmaker H. J Nucl Med 1999;41(S):57P.

    Google Scholar 

  76. van Sonnenberg E, Casola G, Ho M et al. Radiology 1988;167:457–461.

    Google Scholar 

  77. Garcia Rio F, Diaz Lobato S, Pino JM et al. Acta Radiol 1994;35:478–480.

    PubMed  CAS  Google Scholar 

  78. Li H, Boiselle PM, Shepard JO, Trotman-Dickenson B, McLoud TC. Am J Roentgenol 1996;167:105–109.

    CAS  Google Scholar 

  79. Santambrogio L, Nosotti M, Bellaviti N, Pavoni G, Radice F, Caputo V. Chest 1997;112:423–425.

    Article  PubMed  CAS  Google Scholar 

  80. Westcott JL, Rao N, Colley DP. Radiology 1997;202:97–103.

    PubMed  CAS  Google Scholar 

  81. Yankelevitz DF, Henschke CI, Koizumi JH, Altorki NK, Libby D. Clin Imaging 1997;21:107–110.

    Article  PubMed  CAS  Google Scholar 

  82. Hayashi N, Sakai T, Kitagawa M et al. Am J Roentgenol 1998;170:329–331.

    CAS  Google Scholar 

  83. Laurent F, Latrabe V, Vergier B, Montaudon M, Vernejoux JM, Dubrez J. Clin Radiol 2000;55:281–287.

    Article  PubMed  CAS  Google Scholar 

  84. Wallace MJ, Krishnamurthy S, Broemeling LD et al. Radiology 2002;225:823–828.

    Article  PubMed  Google Scholar 

  85. Gould MK, Sanders GD, Barnett PG et al. Ann Intern Med 2003;138:724–735.

    PubMed  Google Scholar 

  86. Cummings SR, Lillington GA, Richard RJ. Am Rev Respir Dis 1986;134:453–460.

    PubMed  CAS  Google Scholar 

  87. Gurney JW. Radiology 1993;186:405–413.

    PubMed  CAS  Google Scholar 

  88. Hartman TE, Tazelaar HD, Swensen SJ, Muller NL. Radiographics 1997;17:377–390.

    PubMed  CAS  Google Scholar 

  89. Quint LE, Park CH, Iannettoni MD. Radiology 2000;217:257–261.

    PubMed  CAS  Google Scholar 

  90. Cahan WG, Shah JP, Castro EB. Ann Surg 1978;187:241–244.

    Article  PubMed  CAS  Google Scholar 

  91. Seemann MD, Beinert T, Dienemann H et al. Eur J Med Res 1996;1:371–376.

    PubMed  CAS  Google Scholar 

  92. Yamashita K, Matsunobe S, Tsuda T et al. Radiology 1995;194:399–405.

    PubMed  CAS  Google Scholar 

  93. Potente G, Guerrisi R, Iacari V et al. Radiol Med 1997;94:182–188.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, University of Kentucky, 800 Rose St, HX315B, Lexington, KY, 40536, USA

    Anil Kumar Attili

Authors
  1. Anil Kumar Attili
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ella A. Kazerooni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anil Kumar Attili .

Editor information

Editors and Affiliations

  1. , Department of Radiology, Miami Children's Hospital, SW 114 Street 7420, Miami, 33156, Florida, USA

    L. Santiago Medina

  2. Harborview Medical Center, Department of Radiology, University of Washington, Ninth Avenue 325, Seattle, 98104-2499, Washington, USA

    C. Craig Blackmore

  3. , Department of Radiology, Emory University School of Medicine, 1364 Clifton Road, NE Suite D112, Atlanta, 30322, USA

    Kimberly Applegate

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer New York

About this chapter

Cite this chapter

Attili, A.K., Kazerooni, E.A. (2011). 23 Imaging of the Solitary Pulmonary Nodule. In: Medina, L., Blackmore, C., Applegate, K. (eds) Evidence-Based Imaging. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-7777-9_23

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-7777-9_23

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-7776-2

  • Online ISBN: 978-1-4419-7777-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation