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Solitary Pulmonary Nodule (cont.)

Solitary Pulmonary Node Module Biopsies

Biopsy is a sample of cells is removed for examination under a microscope. There are different methods to collect biopsy samples from the airway or lung tissue where the solitary pulmonary nodule is located.

Bronchoscopy: This procedure is used for solitary pulmonary nodules that are situated closer to the walls of the airways. A bronchoscope (a thin, flexible, lighted tube with a tiny camera at the end) is inserted through the mouth or nose and down the windpipe. From there, it can be inserted into the airways (bronchi) of the lungs. During bronchoscopy, the health care professional takes a biopsy sample from the solitary pulmonary nodule. If the lesion is not easily accessible on the airway wall or is smaller than 2 cm in diameter, a needle biopsy may be performed. This procedure is called a transbronchial needle aspiration (TBNA) biopsy. Usually, this technique is only successful with the aid of endobronchial ultrasound (EBUS).

Transthoracic needle aspiration (TTNA) biopsy: This type of biopsy is used if the lesion is not easily accessible on the airway wall or is smaller than 2 cm in diameter. If the solitary pulmonary nodule is on the periphery of the lung, a biopsy sample has to be taken with the help of a needle inserted through the chest wall and into the solitary pulmonary nodule. It is usually performed with CT guidance. With solitary pulmonary nodules larger than 2 cm in diameter, the diagnostic accuracy is higher (90% to 95%). However, the accuracy decreases in nodules that are smaller than 2 cm in diameter.

Solitary Pulmonary Nodule Treatment

Based on the results of exams and tests, persons with solitary pulmonary nodule can be divided into the following three groups:

  1. Persons with benign solitary pulmonary nodule: Determining that the solitary pulmonary nodule is benign is based on the following:
    • Persons younger than 35 years without other risk factors
    • Benign appearance on chest X-ray film
    • Stability of the solitary pulmonary nodule over a period of 2 years on chest X-ray film or CT scan
    • Once an solitary pulmonary nodule is determined to be benign, no further workup is necessary. However, one must always consider the overall clinical situation. In some cases, such as in cigarette smokers further monitoring of the lungs may be necessary.
  2. Persons with a malignant solitary pulmonary nodule: Persons who have been diagnosed with a malignant solitary pulmonary nodule based on the results of the exams and tests should have the nodule surgically removed.
  3. Persons with solitary pulmonary nodule that cannot be classified as either benign or malignant: Most persons fall into this category. This is a very challenging population, and often can be followed by serial CT scans monitoring for change or stability of the solitary pulmonary nodule over a two year period.
Medically Reviewed by a Doctor on 2/9/2016

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