MCQ Radiology Answer 24

The correct answer is C

A solitary pulmonary nodule, usually found unexpectedly on chest roentgenography, is a finding that cannot be ignored.Patients who have surgical resections for solitary nodules (pathological stage Ia or T1 N0, M0) have a 60–70% chance of surviving 5 years which is the reported outcome for lung cancer. It is therefore important not to miss the opportunity for surgical cures.

In current practice, the nodule proves to be a malignant tumor in about 40% of cases, most often bronchogenic carcinoma but occasionally a solitary metastasis or carcinoid tumor.

In populations where a large proportion of SPNs are benign there is a potential for greater avoidable surgical morbidity, although fear of litigation may prompt a "play safe" policy of removal of most lesions. Thoracic computed tomography (CT) and fine needle biopsy (FNB) are both advocated to improve the precision of management by increasing the confidence with which masses can be categorised as benign or malignant.

Although each case must be considered individually, there are several basic principles of management in cases of solitary pulmonary nodules:

• Every nodule must be regarded as potentially malignant until proven otherwise.
• Malignant nodules should be resected unless the procedure is contraindicated because of an unacceptably high surgical risk or evidence of metastasis.
• Resection of a benign nodule rarely benefits the patient and carries a small but significant mortality risk. Ruling out malignancy by less-invasive means than thoracotomy is desirable wherever possible.
• A management decision should be reached with reasonable promptness once a solitary pulmonary nodule has been detected. Under certain circumstances, a decision to observe the nodule for a period of time with serial chest films may be appropriate, but this must be a considered approach and not a "default" position.

Category: Radiology MCQs