What guides your general

approach to small lung nodules?

A. Institutional guidelines

B. National / Society guidelines

C. Individualized approach

D. Some combination of above

Small Lung Nodules: What do They Really Do?AATS 2015, Seattle WA

What are acceptable approaches to

small lung nodules for your patients?

A. Surgery only

B. Surgery, SBRT

C. Surgery, SBRT, RFA

D. Surgery, SBRT, RFA, and/or

cryoablation

Small Lung Nodules: What do They Really Do?AATS 2015, Seattle WA

Small lung nodule case#1

• 79 yoF, former smoker• 1.9cm subsolid RUL nodule; no PET• nodule enlarging x 9 months• Open to clinical trial enrollment• FEV1 1.8L, DLCO 72% predicted

Small Lung Nodules: What do They Really Do?AATS 2015, Seattle WA

Small lung nodule case#1

A. Observe, F/U CT scan

B. Image guided biopsy

C. Sublobar resection

D. Completion lobectomy (if

Cancer)

E. Clinical trial enrollment (eg.

CALGB 140503, others)

Small Lung Nodules: What do They Really Do?AATS 2015, Seattle WA

Small lung nodule case#2

• 46 yoM, healthy, prior smoker• Nodule found ~1 year ago on

coronary screening CT scan• ~5mm then, now 9mm• No uptake on PET• FEV1 3.5L

Small Lung Nodules: What do They Really Do?AATS 2015, Seattle WA

Small lung nodule case#2

A. Observe, F/U CT scan

B. Image guided biopsy

C. Sublobar resection

D. Completion lobectomy (if

Cancer)

Small Lung Nodules: What do They Really Do?AATS 2015, Seattle WA

Small lung nodule case#3

• 55 yoM, long time smoker, now quit

• Bad emphysema• FEV1 1.1L, DLCO 42% predicted• RUL nodule 1.1 cm enlarging x 6

months• SUVmax 3.4

Small Lung Nodules: What do They Really Do?AATS 2015, Seattle WA

Small lung nodule case#3

A. Observe, F/U CT scan

B. Image guided biopsy

C. Sublobar resection

D. Completion lobectomy (if

Cancer)

Small Lung Nodules: What do They Really Do?AATS 2015, Seattle WA

Small lung nodule case#4

• Healthy 64 yoM, long time smoker, now quit

• 1.4cm RUL nodule; SUVmax 4.6• nodule enlarging x 6 months• Says no to clinical trial• FEV1 2.4L, DLCO 59% predicted

Small Lung Nodules: What do They Really Do?AATS 2015, Seattle WA

Small lung nodule case#4

A. Observe, F/U CT scan

B. Image guided biopsy

C. Sublobar resection

D. Completion lobectomy (if

Cancer)

Small Lung Nodules: What do They Really Do?AATS 2015, Seattle WA