The prevalence of subcentimeter pulmonary nodules is on the rise due to widespread use of multidetector row computed tomography. These lesions have created a new set of challenges for patients and their physicians. Such nodules are poorly characterized by imaging tests and are difficult to biopsy. Fortunately, the available data suggest that the vast majority of such nodules are benign in etiology. However, this increases the challenge to provide a cost-effective evaluation that minimizes unnecessary radiation exposure and complications from invasive biopsies while promptly identifying malignancy when it is present. In this review, we summarize the current available literature regarding subcentimeter nodules, as well as the current recommendations regarding their investigation.
KEYWORDS
Subcentimeter nodules - evaluation - lung cancer
REFERENCES
1
Winer-Muram H T.
The solitary pulmonary nodule.
Radiology.
2006;
239
34-49
2
Jeong Y J, Yi C A, Lee K S.
Solitary pulmonary nodules: detection, characterization, and guidance for further diagnostic workup and treatment.
AJR Am J Roentgenol.
2007;
188
57-68
7
Henschke C I, McCauley D I, Yankelevitz D F et al..
Early Lung Cancer Action Project: overall design and findings from baseline screening.
Lancet.
1999;
354
99-105
8
Swensen S J, Jett J R, Sloan J A et al..
Screening for lung cancer with low-dose spiral computed tomography.
Am J Respir Crit Care Med.
2002;
165
508-513
9
Henschke C I, Yankelevitz D F, Naidich D P et al..
CT Screening for lung cancer: suspiciousness of nodules according to size on baseline scans.
Radiology.
2004;
231
164-168
10
Gould M K, Maclean C C, Kuschner W G et al..
Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis.
JAMA.
2001;
285
914-924
11
Wahidi M M, Govert J A, Goudar R K, Gould M K, McCrory D C. American College of Chest Physicians .
Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guideline (2nd edition).
Chest.
2007;
132(3 Suppl)
94S-107S
12
Aquino S L, Kuester L B, Muse V V et al..
Accuracy of transmission CT and FDG-PET in the detection of small pulmonary nodules with integrated PET/CT.
Eur J Nucl Med Mol Imaging.
2006;
33
692-696
13
O J H, Yoo IeR, Kim S H, Sohn H S, Chung S K.
Clinical significance of small pulmonary nodules with little or no 18F-FDG uptake on PET/CT images of patients with nonthoracic malignancies.
J Nucl Med.
2007;
48
15-21
14
Gould M K, Kuschner W G, Rydzak C E et al..
Test performance of positron emission tomography and computed tomography for mediastinal staging in patients with non-small-cell lung cancer: a meta-analysis.
Ann Intern Med.
2003;
139
879-892
15
Gould M K, Fletcher J, Iannettoni M D American College of Chest Physicians et al..
Evaluation of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guideline (2nd edition).
Chest.
2007;
132(3 Suppl)
108S-130S
17
Eberhardt R, Anantham D, Ernst A et al..
Multimodality bronchoscopic diagnosis of peripheral lung lesions: a randomized controlled trial.
Am J Respir Crit Care Med.
2007;
176
36-41
18
Hautmann H, Schneider A, Pinkau T et al..
Electromagnetic catheter navigation during bronchoscopy: validation of a novel method by conventional fluoroscopy.
Chest.
2005;
128
382-387
19
Gildea T R, Mazzone P J, Karnak D et al..
Electromagnetic navigation diagnostic bronchoscopy: a prospective study.
Am J Respir Crit Care Med.
2006;
174
982-989
20
Schwarz Y, Greif J, Becker H D et al..
Real-time electromagnetic navigation bronchoscopy to peripheral lung lesions using overlaid CT images: the first human study.
Chest.
2006;
129
988-994
21
Makris D, Scherpereel A, Leroy S et al..
Electromagnetic navigation diagnostic bronchoscopy for small peripheral lung lesions.
Eur Respir J.
2007;
29
1187-1192
22
Yeow K M, Su I H, Pan K T et al..
Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies.
Chest.
2004;
126
748-754
23
Geraghty P R, Kee S T, McFarlane G et al..
CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate.
Radiology.
2003;
229
475-481
24
Lacasse Y, Wong E, Guyatt G H et al..
Transthoracic needle aspiration biopsy for the diagnosis of localised pulmonary lesions: a meta-analysis.
Thorax.
1999;
54
884-893
25
Wallace M J, Krishnamurthy S, Broemeling L D et al..
CT-guided percutaneous fine-needle aspiration biopsy of small (≤ 1 cm) pulmonary lesions.
Radiology.
2002;
225
823-828
26
Suzuki K, Nagai K, Yoshida J et al..
Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules: indications for preoperative marking.
Chest.
1999;
115
563-568
27 Chen T, Kuschner W. Lung cancer: principles and practice. In: Pass H, Carbone D, Minna J, Johnson D and Turrisi A III Non-Tobacco-Related Lung Carcinogenesis. 3rd ed. Philadelphia; Lippincott Williams & Wilkins 2005: 61-76
28
Henschke C I, Yankelevitz D F, Mirtcheva R et al..
CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules.
AJR Am J Roentgenol.
2002;
178
1053-1057
29
Li F, Sone S, Abe H et al..
Malignant versus benign nodules at ct screening for lung cancer: comparison of thin-section CT findings.
Radiology.
2004;
233
793-798
30
Takashima S, Sone S, Li F et al..
Indeterminate solitary pulmonary nodules revealed at population-based CT screening of the lung: using first follow-up diagnostic CT to differentiate benign and malignant lesions.
AJR Am J Roentgenol.
2003;
180
1255-1263
31
Swensen S J, Silverstein M D, Ilstrup D M et al..
The probability of malignancy in solitary pulmonary nodules: application to small radiologically indeterminate nodules.
Arch Intern Med.
1997;
157
849-855
32
Petrou M, Quint L E, Nan B et al..
Pulmonary nodule volumetric measurement variability as a function of CT slice thickness and nodule morphology.
AJR Am J Roentgenol.
2007;
188
306-312
35
MacMahon H, Austin J HM, Gamsu G et al..
Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society.
Radiology.
2005;
237
395-400