By John Gever
CHICAGO, IL -- October 25, 2007 -- Fifty-year-old advice on management of solitary pulmonary nodules (SPN) is accurate despite controversy over the original studies, according to research presented here at CHEST 2007, the annual meeting of the American College of Chest Physicians.
Research published in the mid-1950s led to widespread belief that SPNs that remained stable for 2 years were benign and need not be removed or otherwise treated. However, this belief has recently come into question, and had not been tested systematically with more current data.
Now, new data confirm that stable SPNs are indeed almost always benign, said Nadim Daher, Pulmonary Fellow, Department of Pulmonary and Critical Care Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States, Speaking on October 23.
His group reviewed records of all patients evaluated for SPNs between 1999 and 2007. Chest radiographs and computerised tomography images were analysed along with potential risk factors such as age and smoking status.
The review yielded 42 patients who had a total of 44 SPNs that had been stable for at least 2 years during the study interval and with sufficient records for analysis. The mean followup interval was 1.4 years.
Most lesions ranged from 0.5 to 2.5 cm in diameter; 70% had smooth margins. Most were solid and not calcified and were found in all areas of the lung.
Of the 42 patients, 40 survived with no change in SPN size or shape during the study period. One patient died more than 5 years after the nodule was first identified, with no change seen in the SPN at autopsy. In one patient, the SPN was seen to grow with a doubling time of 1,719 days, according to Dr. Daher, who said that doubling times for malignant lesions are typically in the range of 20 to 400 days.
He said these data support the long-held belief that SPNs remaining stable for 2 years do not require further evaluation or treatment.
[Presentation title: Radiographic Follow-Up of Stable Lung Nodules. Session 921]
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