Transcript Management of Solitary Pulmonary Nodule

Management of Solitary
Pulmonary Nodule
Marvin D. Peyton, M.D.
Thoracic and Cardiovascular Surgery
University of Oklahoma Health Sciences Center
Chest X-Ray
Seek old films
Allows for general assessment of quantity
and quality
CT Scan
Allows more qualitative and quantitative
assessment of nodule
Allows assessment of mediastinum for
adenopathy and invasion, as well as chest
wall for invasion
Allows assessment of liver and adrenal
and thoracic skeleton
PET Scan
Allows assessment for likelihood of
malignant process
Allows assessment of other foci of
metastatic disease
MRI
Important to differentiate involvement with
vascular structures, as well as brachial
plexus in the thoracic apex
May be more sensitive than PET scanning
Bronchoscopy
Diagnosis by direct observation, biopsy
and appropriate brushings and washings,
as well as assessment of endobronchial
tree for satellite lesions
Biopsy
Transthoracic
Transbronchial
Mediastinoscopy
Assessment of metastatic disease to
mediastinal lymph nodes
Ultrasound-Guided Transbronchial
or Transesophageal Biopsy of
Mediastinal Adenopathy
Preoperative assessment
Blood gas assessment
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pO2>65
pCO2<65
Spirometry
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FEV1
MVV
Cardiac Ultrasound
Cardiac Catheterization
Right and left heart catheterization for
assessment of coronary integrity, left
ventricular function and right heart function
by pressure analysis
Surgical Treatment
Wedge excision for biopsy or definitive
therapy
Lobectomy
Pneumonectomy
Lymph node sampling and dissection for
staging
Prognosis by tumor classification
Stage IA – 85% cure
Diagnostic
Sputum analysis