Question

With the help of a flow-chart describe the diagnostic and therapeutic algorithm of SPNs.

Hint:

In high-risk patients, a biopsy or PET scan is essential to determine the malignancy of SPNs, whereas low-risk patients can often be monitored with periodic imaging.

Answer 1

The diagnostic and therapeutic approach to SPNs involves assessing the risk of malignancy, imaging, and, in some cases, biopsy or surgical resection. The following flow-chart outlines the algorithm for managing SPNs:
Step 1: Initial Evaluation:
- History and physical examination, including risk factors such as age, smoking, or history of cancer.
- Initial chest X-ray or CT scan to identify and characterize the nodule (size, edges, calcification).
Step 2: Risk Stratification:
- Low risk (e.g., small, non-growing nodule in a young, non-smoker): Follow-up with serial imaging (CT scan) over time.
- High risk (e.g., large, spiculated, growing nodule in an older smoker): Further evaluation with PET scan, biopsy, or surgical resection.
Step 3: Management Based on Risk:
- Benign nodule (low risk, stable): No further intervention, periodic imaging.
- Suspicious or malignant nodule (high risk, growing, PET positive): Surgical resection or biopsy for histological diagnosis and staging.
Step 4: Follow-up and Monitoring:
- Regular follow-up imaging (CT scan) at appropriate intervals for stable or benign nodules.
- For malignant or suspected malignant nodules, treatment options include surgery, radiation, or chemotherapy based on biopsy results.