Lung nodule management: a new classification proposal

Abstract

Management of solitary pulmonary nodule (SPN) and micronodule (SPMN) is still debated. The use of 18F-FDG PET/CT or CT multislice screening for early lung cancer detection, have increased the frequency of displaying indeterminate single lung nodule with diameter between 0.1 cm and 2 cm. The first choice is to wait and do radiological follow-up, since the evaluation of temporal changes in a small mass may contribute to differentiate a malign from benign pathology. In case of unchanged images not capable of orientating the diagnostician or no possible preoperative diagnosis by bronchoscopy and percutaneous needle biopsy, surgical treatment is necessary allowing the histological characterization of lesion and a good prognosis of disease. Video-assisted thoracoscopic surgery and muscle-sparing minithoracotomy have become routine, each of these furnishing precise indications. The purpose of the study was to establish the main investigative method for indeterminate lung nodules, considering the continuous evolution of endoscopic and radiological techniques.