Radiologic clinics of North America
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Radiol. Clin. North Am. · Sep 2012
ReviewEvaluation and management of indeterminate pulmonary nodules.
The radiologic evaluation and management of the indeterminate solitary pulmonary nodule provide common diagnostic dilemma. With continued technologic advancements in multidetector computed tomography leading to higher spatial resolution and greater overall sensitivity of computed tomography scanners, increasing numbers of indeterminate solitary pulmonary nodules are being detected. Malignant and benign solitary pulmonary nodules have similar imaging features. Clinical management of these incidental nodules relies not only on imaging characteristics but also on malignancy risk factors, along with the risks and benefits of further investigation.
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Screening with low-dose computed tomography reduces mortality from lung cancer in high-risk patients. Lung cancer screening with chest radiography alone or in combination with sputum analysis is currently not recommended. ⋯ A standardized framework for testing and management in a multidisciplinary fashion is necessary to provide lung cancer screening. The National Comprehensive Cancer Network and the American Lung Association have recently issued guidelines for lung cancer screening with computed tomography in high-risk patients.
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Lung cancer is a heterogenous disease with 2 main subtypes: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Early-stage NSCLC is managed primarily by surgical resection, with adjuvant chemotherapy for selected patients with stage IB, II, and III disease. ⋯ Advanced NSCLC remains an incurable disease. Further advances will rely on improvements in understanding of the molecular events driving the malignant phenotype and the development of novel, targeted therapeutic strategies.