Questions for Discussion:

1. What is the definition of a solitary pulmonary nodule? Answer
2. What is your differential diagnosis for the etiology of this solitary pulmonary nodule? Answer
3. What is the first thing you should do when presented with an abnormal chest x-ray as you try to sort out the differential above? Answer
4. What chest CT scan characteristics might predict a greater or lesser chance of this lesion being benign versus malignant. Answer
5. If this lesion is malignant, what is its clinical stage? What would be the predicted 5-year survival with surgical resection? Answer
6. Discuss the role for FDG-PET in the evaluation of patients with proven or suspected lung cancer. What is the average reported FDG-PET sensitivity and specificity for identifying lung cancer in pulmonary nodules > 1 cm in size? Answer
7. What are your three basic options for further evaluation of this chest x-ray abnormality? Discuss the relative merits of each option. What would be your formal recommendation for this patient? Answer
8. Discuss any further pulmonary evaluation that might be necessary before surgical resection could be recommended? Answer
9. The patient undergoes PFT’s and is found to have a FEV₁ of 1.5 liters. Assuming that surgery would remove one lobe, is the patient still a candidate for resection? Answer
10. Discuss the role of quantitative perfusion scanning in the preoperative evaluation of lung resection candidates. Answer
11. Radiology obviously plays a key role in the evaluation of suspected or proven cases of lung cancer. Discuss the data regarding the role for Screening for Lung Cancer. Answer

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