How to Follow Up Lung Nodules on CXR
Instructions
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Obtain old chest X-rays to compare with the current ones. If the nodules are new or have grown in size from the previous chest X-ray, further testing is needed.
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Get a CT scan to look at the pattern of calcification of the nodules. Certain calcification patterns on chest X-rays and CT scans suggest that a nodule is more likely to be malignant.
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Schedule a PET scan if the CT scan doesn't clarify whether the nodules are benign or malignant. According to a study published in the September 2000 issue of the "American Journal of Respiratory and Critical Care Medicine," a PET scan can determine whether a nodule is malignant with 95 percent sensitivity and 85 percent specificity. This means it will pick up a cancer 95 percent of the time when one is present and will be correct 85 percent of the time. In 15 percent of the cases, what appears to be a malignancy will actually be benign. PET scans, however, are not available in all areas.
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Decide whether to follow the nodules with serial chest X-rays or chest CT scans every three months or undergo tissue diagnosis based on the results of the preceding studies.
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Proceed with serial three-month imaging studies or tissue diagnosis using fiber-optic bronchoscopy or fine needle aspiration of the nodule or nodules.
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