Screen discovered nodules what next
This presentation is the property of its rightful owner.
Sponsored Links
1 / 28

Screen discovered nodules: What next ? PowerPoint PPT Presentation


  • 42 Views
  • Uploaded on
  • Presentation posted in: General

Screen discovered nodules: What next ?. 18 th Annual Perspectives in Thoracic Oncology. Anil Vachani, MD, MS Assistant Professor of Medicine Director, Lung Nodule Program University of Pennsylvania Medical Center. Disclosures. Research Funding NIH, DOD

Download Presentation

Screen discovered nodules: What next ?

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Screen discovered nodules what next

Screen discovered nodules: What next?

18th Annual Perspectives in Thoracic Oncology

Anil Vachani, MD, MS

Assistant Professor of Medicine

Director, Lung Nodule Program

University of Pennsylvania Medical Center


Disclosures

Disclosures

  • Research Funding

    • NIH, DOD

    • Integrated Diagnostics, Allegro Diagnostics,

  • Scientific Advisory Board

    • Allegro Diagnostics


Nodule biopsy and benign disease rates

Nodule, Biopsy and Benign Disease Rates

5

RCT

4

3

Percent of patients in screened arm

2

1

0


Screen discovered nodules what next

Ost & Gould, AJRCCM 2011


Assessing the probability of cancer

Assessing the Probability of Cancer

  • Most Important Factors to consider:

    • Nodule size and characteristics

    • Smoking history

    • Age

    • Family history of lung cancer

    • Emphysema


Screen discovered nodules what next

http://www.brocku.ca/lung-cancer-risk-calculator


Screen discovered nodules what next

http://www.brocku.ca/lung-cancer-risk-calculator


Importance of nodule size

Importance of Nodule Size

NLST Investigators. NEJM 2013


Guidelines

Guidelines


Fleischner society guidelines

Fleischner Society Guidelines

McMahon, et al. Radiology 2005; 237:395-400


Recommendations for subsolid nodules

Recommendations for Subsolid Nodules


Screen discovered nodules what next

Thick vs. Thin Sections for Small Nodules

Naidich D P et al. Radiology 2013;266:304-317


Recommendations for subsolid nodules1

Recommendations for Subsolid Nodules


Pure ggn larger than 5mm

Pure GGN larger than 5mm

  • Lesions are frequently due to preinvasive AAH or AIS

  • Up to 20% of persistent GGOs are benign

  • Growth of a GGO can suggest presence of an invasive adenocarcinoma


Screen discovered nodules what next

Serial Imaging to Assess Growth (1mm cuts)

Naidich D P et al. Radiology 2013;266:304-317


Screen discovered nodules what next

Rapid Enlargement of a GGO

Naidich D P et al. Radiology 2013;266:304-317


Recommendations for subsolid nodules2

Recommendations for Subsolid Nodules


Rationale

Rationale

  • Part solid nodules have a high likelihood of malignancy

  • Development of a solid component within a pure GGO


Recommendations for subsolid nodules3

Recommendations for Subsolid Nodules


Screen discovered nodules what next

Multiple subsolid lesions with single dominant focus.

Naidich D P et al. Radiology 2013;266:304-317


Pet scans

PET Scans

Erasmus, et al. Clinics in Chest Medicine 2008


Pet scans1

PET Scans

  • Sensitivity ~ 85%

  • Specificity ~ 80%

  • Less accurate for:

    • Smaller lesions

    • Subsolidnodlues


Establishing a tissue diagnosis

Establishing a Tissue Diagnosis

  • Bronchoscopy vs. CT guided TTNA


Establishing a tissue diagnosis1

Establishing a Tissue Diagnosis

  • Bronchoscopy vs. CT guided TTNA

  • Data based on case series

  • Risks of CT guided TTNA

    • Pneumothorax 15-27%


Conclusions

Conclusions

  • Lung nodules are increasingly common

  • Important to elicit patient preferences

  • Management should include

    • Estimation of cancer risk

  • Nodules ÔëĄ 8mm are infrequently malignant

    • CT scan surveillance is best option in most cases

  • If high likelihood of malignancy and low surgical risk, consider surgical evaluation

  • Emergence of peripheral blood biomarkers


Screen discovered nodules what next

THANK YOU


  • Login