Evaluation of Patients With Pulmonary Nodules: When Is It Lung Cancer?

Gould, Michael K.; Fletcher, James; Iannettoni, Mark D.; Lynch, William R.; Midthun, David E.; Naidich, David P.; Ost, David

doi:10.1378/chest.07-1353

Cited by 457 publications

(408 citation statements)

References 195 publications

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“…A number of clinical factors impact the likelihood of malignancy with in an SPN, but the most important of these are the patient's age, history of smoking, and history of prior malignancy (2).…”

Section: Clinical Characteristics Impacting the Likelihood Of Malignamentioning

confidence: 99%

“…The ability of clinical, laboratory, and imaging features to impact the likelihood of a benign or malignant SPN diagnosis is often quantified in terms of likelihood ratios (LRs); LR's for individual imaging features of SPNs have been published (7,12). The likelihood ratios for various clinical factors, along with imaging features of SPNs, can be combined to provide an overall assessment of the likelihood of malignancy for a given SPN (2). For example, the likelihood ratio for an upper lobe location for an SPN has been reported as 1.22 in one publication (7)-this value indicates a slightly increased likelihood of malignancy when an SPN is found in the upper lobes as opposed to other locations.…”

Section: Likelihood Ratiosmentioning

confidence: 99%

“…As a general rule, the rate of malignancy within a nodule rises as nodule size increases (2). Unfortunately, there is no lower size limit at which malignancy can be confidently excluded.…”

Section: Nodule Sizementioning

confidence: 99%

“…The Fleischner Society (1) defines a solitary pulmonary nodule (SPN) as a rounded opacity, circumscribed or poorly defined, measuring up to 3 cm in diameter, completely surrounded by lung. In the most restrictive definition, SPNs are unassociated with atelectasis, hilar enlargement, or pleural effusion (2,3). Opacities larger than 3 cm in diameter are referred to as masses to reflect to high rate of malignancy with lesions of this size (2,4).…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of SPNs at chest radiography has been estimated at 1 in 500 chest radiographs (2,3). Nodules are even more commonly detected at thoracic CT, and the problem of the incidental detection of pulmonary nodule is increasing due to the higher sensitivity of thoracic CT compared with chest radiography, as well as the increasing utilization of thoracic CT (5).…”

Section: Introductionmentioning

confidence: 99%

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Imaging Evaluation of the Solitary Pulmonary Nodule

Tassel

Gotway

et al. 2011

Clinical Pulmonary Medicine

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Section: Clinical Characteristics Impacting the Likelihood Of Malignamentioning

confidence: 99%

Section: Likelihood Ratiosmentioning

confidence: 99%

“…As a general rule, the rate of malignancy within a nodule rises as nodule size increases (2). Unfortunately, there is no lower size limit at which malignancy can be confidently excluded.…”

Section: Nodule Sizementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Imaging Evaluation of the Solitary Pulmonary Nodule

Tassel

Gotway

et al. 2011

Clinical Pulmonary Medicine

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Accuracy of FDG-PET to Diagnose Lung Cancer in Areas With Infectious Lung Disease

Deppen

Blume

Kensinger

et al. 2014

JAMA

155

119

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Importance Positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) is recommended for the non-invasive diagnosis of pulmonary nodules suspicious for lung cancer. In populations with endemic infectious lung disease, FDG-PET may not accurately identify malignant lesions. Objective To estimate the diagnostic accuracy of FDG-PET for pulmonary nodules suspicious for lung cancer in regions where infectious lung disease is endemic and compare the test accuracy in regions where infectious lung disease is rare. Data Sources and Study Selection Databases of MEDLINE, EMBASE and the Web of Science were searched from October 1, 2000, through April 28, 2014. Articles reporting information sufficient to calculate sensitivity and specificity of FDG-PET to diagnose lung cancer were included. Only studies that enrolled more than 10 participants with benign and malignant lesions were included. Database searches yielded 1923 articles, of which 257 were assessed for eligibility. Seventy studies were included in the analysis. Studies reported on a total of 8511 nodules; 5105 (60%) were malignant. Data Extraction and Synthesis Abstracts meeting eligibility criteria were collected by a research librarian and reviewed by 2 independent reviewers. Hierarchical summary receiver operating characteristic curves were constructed. A random-effects logistic regression model was used to summarize and assess the effect of endemic infectious lung disease on test performance. Main Outcome and Measures The sensitivity and specificity for FDG-PET test performance. Results Heterogeneity for sensitivity (I2=87%) and specificity (I2=82%) was observed across studies. The pooled (unadjusted) sensitivity was 89% (95% CI, 86%-91%) and specificity was 75% (95% CI, 71%-79%). There was a 16% lower average adjusted specificity in regions with endemic infectious lung disease (61% [95% CI, 49%-72%]) compared with nonendemic regions (77% [95% CI, 73%-80%]). Lower specificity was observed when the analysis was limited to rigorously conducted and well-controlled studies. In general, sensitivity did not change appreciably by endemic infection status, even after adjusting for relevant factors. Conclusions and Relevance The accuracy of FDG-PET for diagnosing lung nodules was extremely heterogeneous. Use of FDG-PET combined with computed tomography was less specific in diagnosing malignancy in populations with endemic infectious lung disease compared with nonendemic regions. These data do not support use of FDG-PET to diagnose lung cancer in endemic areas unless an institution achieves test performance accuracy similar to that found in nonendemic regions.

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Minimally Invasive Endoscopic Staging of Suspected Lung Cancer

Wallace¹

2008

JAMA

388

226

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UNG CANCER IS THE MOST COMmon cancer-related cause of death in the United States. 1 Stage of disease dictates the choice of therapy. Surgery is most appropriate for patients in whom disease is confined to the lung and hilar lymph nodes. For patients with ipsilateral mediastinal lymph node metastases, the benefit of surgery as primary therapy is questionable. For patients with contralateral mediastinal lymph node metastases, surgery is generally not indicated, and chemotherapy, radiotherapy, or both are considered the standard of care. 2 Noninvasive staging with chest computed tomography (CT) or positron emission tomography (PET) is associated with high rates of false-positive and false-negative results, respectively. 3 The American College of Chest Physicians recommends invasive staging with tissue confirmation of suspected metastatic mediastinal lymph nodes. 4 Mediastinoscopy or thoracoscopy has been the diagnostic standard, but less invasive methods have emerged as potential alternatives. Such methods include blind transbronchial needle aspiration (TBNA), endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), and, most recently, endobronchial ultrasound-guided fineneedle aspiration (EBUS-FNA). 5 We hypothesized that EBUS-FNA would be more accurate than TBNA and that the combination of EUS-FNA and EBUS

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Evaluation of Patients With Pulmonary Nodules: When Is It Lung Cancer?

Cited by 457 publications

References 195 publications

Imaging Evaluation of the Solitary Pulmonary Nodule

Imaging Evaluation of the Solitary Pulmonary Nodule

Accuracy of FDG-PET to Diagnose Lung Cancer in Areas With Infectious Lung Disease

Minimally Invasive Endoscopic Staging of Suspected Lung Cancer

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