Small solitary pulmonary nodules: assessment of enhancement and enhancement patterns in benign and malignant tumours by high resolution computed tomography.
Our aim was to determine the accuracy of quantitative and qualitative findings of contrast-enhanced computed tomography (CT) by means of differential analysis of small uncalcified solitary pulmonary nodules and to compare the CT diagnosis with the results of transthoracic needle biopsies (TTNB). We assessed a consecutive series of 109 patients with 66 malignant or 45 benign pulmonary nodules before TTNB and surgery with contrast and high resolution computed tomography (HRCT). Pulmonary nodules were classified as small when equal to or smaller than 15 mm and large when larger than 15 mm. Diagnostic accuracy of CT qualitative evaluation was 95% for large nodules and 92% for small nodules. Specificity was 92% for small nodules, 80% for large nodules. Enhancing regular septa were observed in 28 hamartomas (80%) while except for two cases (3%), inner septa were absent or irregular in malignant tumours. TTNB accuracy was 70% for small nodules and 94% for large ones. Low-enhancing hamartomas are more frequent in Italy than in the US where the prevalence of high-enhancing granulomas in benign nodules reduces the specificity of quantitative CT analysis. We propose that certain geographic areas would benefit from enhanced-CT in place of TTNB in managing lung nodules equal to or less than 1.5 cm.
Potente
G
G
Department of Radiology, University La Sapienza of Rome.
D'Andrea
V
V
Cantisani
V
V
Berni
A
A
De Antoni
E
E
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001706:Biopsy; D002276:Carcinoid Tumor / Q000000981:diagnostic imaging / Q000473:pathology; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology; D018277:Carcinoma, Mucoepidermoid / Q000000981:diagnostic imaging / Q000473:pathology; D018288:Carcinoma, Small Cell / Q000000981:diagnostic imaging / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006099:Granuloma / Q000000981:diagnostic imaging / Q000473:pathology; D006222:Hamartoma / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods; D014375:Tuberculoma / Q000000981:diagnostic imaging / Q000473:pathology; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging / Q000473:pathology