Dazy Posted February 14, 2006 Share Posted February 14, 2006 Whew!! Yes, that is a BIG difference - the difference 'tween a mass, and a nodule I believe (3.0 - 3.5 cm is the threshold, I think) Well, glad that it is only mm's, but do keep an eye on it. Good info, Carol. I've read that same article. There is an updated version (2003)at the following site: http://www.postgradmed.com/issues/2003/08_03/sullivan.htm The site below will assist any math challenged nodule watchers in determining volume doubling times (VDT's) if you have had interval growth on CT, and also has excellent info on variants/limitations in CT reading, and interpretation, etc. http://www.chestx-ray.com/SPN/DoublingTime.html The article below has good info regarding types of LC and their average VDT's, however, it fails to mention BAC, which has a significantly longer doubling time than the average adenocarcinoma VDT, often longer than the 450-500 days considered for suspicious for malignancy. It also has good information regarding other indicators for malignant versus benign nodules. It is a bit long, but I posted it here for those NW's who are unable to pull it up online: http://www.indianchestsociety.org/ Solitary Pulmonary Nodule Solitary pulmonary nodule (SPN) represents a single discrete intrapulmonary nodule(Fig 1) with any contour (smooth, lobulated, umbilicated), with or without calcification, cavitation, satellite lesions, and symptoms. Differential Diagnosis: Infections: a. Mycobacterial -- Tuberculoma b. Bacterial: Lung abscess, Round pneumonia. c. Parasitic -- Echinococcus granulosus d. Fungal - Histoplasmosis, Coccidiodomycosis Tumors: a. Malignant -- Bronchogenic carcinoma, metastatic nodule. b. Benign -- Bronchial adenoma. Developmental: a. Bronchogenic cyst. b. Sequestration. Traumatic: a. Hematoma b. Traumatic lung cyst Immunological disorders: a. Rheumatoid nodule b. Wegener's granulomatosis Vascular: Pulmonary arteriovenous malformations (PAVM). Pleural disorders: Round atelectasis. Approach to diagnosis: At the outset it is important to confirm that the nodule is indeed intrapulmonary and not a chest wall lesion. Hence a lateral view is mandatory to confirm this and also to exactly localize the nodule. Also keep in mind that 40-50% of all solitary pulmonary nodules are malignant, hence the probability of the nodule being malignant should be assessed. To ascertain the cause of the SPN, the following characteristics on a chest radiograph or CT scan should be taken into account. Margins: Lobulated margins, umbilication, notching, strand like pseudopodal projections, "sunburst" appearance all indicate malignancy. Well defined margins indicate a benign nodule. Patterns of calcification on chest radiograph or CT densitometry: Central, popcorn like, laminated or diffuse patterns all suggest benign nodules, while an eccentric or a stippled pattern suggest malignancy. Satellite lesions: Tuberculomas. Rib erosions suggest a malignant nodule. Comet tail or vacuum cleaner effect due to crowded vessels, in round atelectasis. In addition it is important to review the older radiographs and calculate the doubling time. Doubling time (DT) is the interval of time required for the nodule to double in volume. It is calculated as the time required to increase the diameter 1.28 times or 28% increase in the diameter. DT can be calculated if two radiographs showing the nodule are available and there is sufficient interval of time between them to allow detectable growth. If prior chest films show no tumor, an upper limit doubling time (ULDT) can be calculated by assuming that the nodule was present and was just 8millimetres in diameter (which is the lower margin of detectability) in the most recent negative film. The ULDT detected in this way is the maximum possible for this nodule. The actual DT may be much lower. DT helps in assessing the likelihood of malignancy as DT< 20-30 days -- Acute infectious process DT> 450 days -- Benign nodules DT= 60-80 days -- Squamous cell carcinoma, large cell carcinoma. DT= 120 days -- Adenocarcinoma DT=30 days -- Small cell carcinoma. Assessment of probability of carcinoma includes evaluation of the following factors: Age: More than 35 years of age increases chances of the nodule being malignant. Smoking either current or past is a risk factor. Calcification pattern as mentioned before. Calculation of the doubling time, as a DT of between 1 to 18 months suggests malignancy. After assessing the probability of carcinoma, a decision may be taken to perform thoracotomy and excision of the nodule or Image assisted Fine Needle Aspiration Biopsy. Alternatively if the probability of carcinoma is very low the patient can be kept under observation and radiographs can be taken at frequent intervals to assess for an increase in size. ***************************************************** Note: I noticed the article above does not mention the complete lack of calcification when discussing calcification patterns. Complete lack of calcification is usually seen more in malignancies, but can also be the case with some granulomas... Hope this will help some of you NW Clubbers out there! As for me...I go tomorrow a.m. for my 3 month CT... Wish me luck! Prayers for HOPE & Health to All! ~Stacey Quote Link to comment Share on other sites More sharing options...
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