What guides your general approach to small lung nodules? A.Institutional guidelines B.National / Society guidelines C.Individualized approach D.Some combination.

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Presentation transcript:

What guides your general approach to small lung nodules? A.Institutional guidelines B.National / Society guidelines C.Individualized approach D.Some combination of above 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 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 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 , others) A.Observe, F/U CT scan B.Image guided biopsy C.Sublobar resection D.Completion lobectomy (if Cancer) E.Clinical trial enrollment (eg. CALGB , 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 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) 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 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) 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 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) 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