Solitary pulmonary nodules: Part I. Morphologic evaluation for differentiation of benign and malignant lesions.


Journal Article (Review)

The solitary pulmonary nodule is a common radiologic abnormality that is often detected incidentally. Although most solitary pulmonary nodules have benign causes, many represent stage I lung cancers and must be distinguished from benign nodules in an expeditious and cost-effective manner. Evaluation of specific morphologic features of a solitary pulmonary nodule with conventional imaging techniques can help differentiate benign from malignant nodules and obviate further costly assessment. Small size and smooth, well-defined margins are suggestive of but not diagnostic for benignity. Lobulated contour as well as an irregular or spiculated margin with distortion of adjacent vessels are typically associated with malignancy. There is considerable overlap in the internal characteristics (eg, attenuation, cavitation, wall thickness) of benign and malignant nodules. The presence of intranodular fat is a reliable indicator of a hamartoma. The presence and pattern of calcification can also help differentiate benign from malignant nodules. Computed tomography (CT) (particularly thin-section CT) is 10-20 times more sensitive than standard radiography and allows objective, quantitative assessment of calcification. Initial evaluation often results in nonspecific findings, in which case nodules are classified as indeterminate and require further evaluation to exclude malignancy. Growth rate assessment, Bayesian analysis, contrast material-enhanced CT, positron emission tomography, and transthoracic needle aspiration biopsy can be useful in this regard.

Full Text

Duke Authors

Cited Authors

  • Erasmus, JJ; Connolly, JE; McAdams, HP; Roggli, VL

Published Date

  • January 2000

Published In

Volume / Issue

  • 20 / 1

Start / End Page

  • 43 - 58

PubMed ID

  • 10682770

Pubmed Central ID

  • 10682770

International Standard Serial Number (ISSN)

  • 0271-5333

Digital Object Identifier (DOI)

  • 10.1148/radiographics.20.1.g00ja0343


  • eng

Conference Location

  • United States