How to Follow Up Lung Nodules on CXR

Lung nodules can be benign or malignant.

Lung nodules on a chest X-ray (CXR) can be malignant or benign. Benign lung nodules are usually caused by an inflammatory condition such as a fungal infection or tuberculosis, while malignant lung nodules are due to cancer. Lung nodules are more likely to be malignant in people who are older and have a smoking history. It's important for this distinction to be made, so the patient can get early treatment if the nodule proves to be cancer.

Instructions

1. Obtain old chest X-rays to compare with the current ones. If the nodules are new or have grown in size from the previous chest X-ray, further testing is needed.

2. Get a CT scan to look at the pattern of calcification of the nodules. Certain calcification patterns on chest X-rays and CT scans suggest that a nodule is more likely to be malignant.

3. Schedule a PET scan if the CT scan doesn't clarify whether the nodules are benign or malignant. According to a study published in the September 2000 issue of the "American Journal of Respiratory and Critical Care Medicine," a PET scan can determine whether a nodule is malignant with 95 percent sensitivity and 85 percent specificity. This means it will pick up a cancer 95 percent of the time when one is present and will be correct 85 percent of the time. In 15 percent of the cases, what appears to be a malignancy will actually be benign. PET scans, however, are not available in all areas.

4. Decide whether to follow the nodules with serial chest X-rays or chest CT scans every three months or undergo tissue diagnosis based on the results of the preceding studies.

5. Proceed with serial three-month imaging studies or tissue diagnosis using fiber-optic bronchoscopy or fine needle aspiration of the nodule or nodules.

Tips & Warnings

• Lung nodules that don't increase in size over a two-year period are usually benign.

• Benign lung nodules usually have smooth edges on chest X-rays.

References

• "Murray and Nadel's Textbook of Respiratory Medicine"; Robert J. Mason et al; 2010.
• "Clinics in Chest Medicine"; Role of Bronchoscopy in the Evaluation of Solitary Pulmonary Nodules; Christopher Hergott; March 2010.
• "Merck Manual, 18th Ed."; Mark H. Beers; 2006.
• ""American Journal of Respiratory and Critical Care Medicine"; Evaluation and Management of the Solitary Pulmonary Nodule; David Ost and Alan Fein; September 2000.

Resources

• Read this Article in Spanish