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Solitary Pulmonary Nodule

Solitary Pulmonary Nodule Treatment

Based on the results of exams and tests, a person with SPN can be divided into one of the following three groups:
 

  • Persons with benign SPN: Persons who have been diagnosed with benign SPN should undergo chest X-ray or CT scans every three to four months in the first year, every six months in the second year, and once every year for up to five years. Determining that the SPN is benign is based on the following:
    • Persons younger than 35 years without other risk factors
    • Benign appearance on chest X-ray
    • Stability of the SPN over a period of two years on chest X-rays
  • Persons with a malignant SPN: Persons who have been diagnosed with a malignant SPN based on the results of the exams and tests should have the nodule surgically removed.
  • Persons with SPN that cannot be classified as either benign or malignant: Most persons fall into this category. However, as many as 75% of these patients have malignant nodules on further evaluation. Therefore, such persons are also advised to have it surgically removed.

SPN Surgery

The SPN should be surgically removed in patients who have (1) a moderate-to-high risk for cancer and clinical signs that indicate that the nodule is malignant or (2) a nodule whose malignancy status cannot be determined even after a biopsy.

SPN is removed surgically by either thoracotomy (open lung surgery) or a video-assisted thoracoscopic surgery (VATS).

  • Thoracotomy involves making a cut in the chest wall and removing small wedges of lung tissue. Patients undergoing this procedure are usually required to stay in the hospital for several days afterward.
  • Video-assisted thoracoscopy is performed with the help of a thoracoscope (a flexible, lighted tube with a tiny camera at the end) inserted into the chest through a small cut on the chest wall. The camera displays the image on a TV screen, and the surgeon uses the display to guide the operation. Its advantages over thoracotomy include a shorter recovery time and a smaller incision.

Next Steps

Follow-up 

  • Persons who have been diagnosed with a benign SPN should schedule the recommended follow-up, as follows:
    • Chest X-rays or CT scans every three to four months in the first year, every six months in the second year, and once every year for up to five years.
    • The time between follow-up evaluations may be longer if there is a low risk of cancer, if the nodule is smaller than one centimeter in diameter, and the patient is a non-smoker.

 

 

SPN Prevention

Avoiding the possible causes may help prevent SPN from forming. Possible avoidable causes include the following:

  • Smoking
  • Traveling to areas with lots of cases of mycosis (histoplasmosis, coccidioidomycosis, blastomycosis) or to areas with a high prevalence of tuberculosis
  • Occupational exposure to risk factors for lung cancer (such as asbestos, radon, nickel, chromium, vinyl chloride, polycyclic hydrocarbons)

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