Management of Solitary Management of Solitary Pulmonary NodulePulmonary Nodule

Marvin D. Peyton, M.D. Marvin D. Peyton, M.D. Thoracic and Cardiovascular SurgeryThoracic and Cardiovascular Surgery

University of Oklahoma Health Sciences CenterUniversity of Oklahoma Health Sciences Center

Chest X-RayChest X-Ray

Seek old filmsSeek old films

Allows for general assessment of quantity Allows for general assessment of quantity and quality and quality

CT ScanCT Scan

Allows more qualitative and quantitative Allows more qualitative and quantitative assessment of noduleassessment of nodule

Allows assessment of mediastinum for Allows assessment of mediastinum for adenopathy and invasion, as well as chest adenopathy and invasion, as well as chest wall for invasionwall for invasion

Allows assessment of liver and adrenal Allows assessment of liver and adrenal and thoracic skeleton and thoracic skeleton

PET ScanPET Scan

Allows assessment for likelihood of Allows assessment for likelihood of malignant processmalignant process

Allows assessment of other foci of Allows assessment of other foci of metastatic disease metastatic disease

MRI MRI

Important to differentiate involvement with Important to differentiate involvement with vascular structures, as well as brachial vascular structures, as well as brachial plexus in the thoracic apexplexus in the thoracic apex

May be more sensitive than PET scanning May be more sensitive than PET scanning

BronchoscopyBronchoscopy

Diagnosis by direct observation, biopsy Diagnosis by direct observation, biopsy and appropriate brushings and washings, and appropriate brushings and washings, as well as assessment of endobronchial as well as assessment of endobronchial tree for satellite lesions tree for satellite lesions

BiopsyBiopsy

TransthoracicTransthoracic

Transbronchial Transbronchial

Mediastinoscopy Mediastinoscopy

Assessment of metastatic disease to Assessment of metastatic disease to mediastinal lymph nodes mediastinal lymph nodes

Ultrasound-Guided Transbronchial Ultrasound-Guided Transbronchial or Transesophageal Biopsy of or Transesophageal Biopsy of

Mediastinal Adenopathy Mediastinal Adenopathy

Preoperative assessmentPreoperative assessment

Blood gas assessmentBlood gas assessment pOpO22>65>65

pCOpCO22<65<65

Spirometry Spirometry FEV1FEV1 MVVMVV

Cardiac UltrasoundCardiac Ultrasound

Cardiac CatheterizationCardiac Catheterization

Right and left heart catheterization for Right and left heart catheterization for assessment of coronary integrity, left assessment of coronary integrity, left ventricular function and right heart function ventricular function and right heart function by pressure analysis by pressure analysis

Surgical TreatmentSurgical Treatment

Wedge excision for biopsy or definitive Wedge excision for biopsy or definitive therapytherapy

LobectomyLobectomy

PneumonectomyPneumonectomy

Lymph node sampling and dissection for Lymph node sampling and dissection for stagingstaging

Prognosis by tumor classificationPrognosis by tumor classification

Stage IA – 85% cure Stage IA – 85% cure

DiagnosticDiagnostic

Sputum analysis Sputum analysis