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  #1  
Old 11-05-2013
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Lungs UW dilemma in pulmonary nodule!

In UW Qustion ID 4596 an incidental pulmonary nodule is found on x-ray...the Question asks what is the next step in management? The patient is 53 YO and is an ex-smoker so obviously hes high risk

Amongst the answers are:

CT
Percutanous biopsy
Bronchoscopy

According to what I learnt in kaplan and MTB the next logical step would be to do open lung biopsy is the right answer, & closet one to that is percuatous biopsy in my opinion

Yet UW says next step is CT to evaluate whether it has malignant features or not, if it does then go for percutanous biopsy

Who is wrong?? UW or MTB??

plzzzzzzz help
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  #2  
Old 11-05-2013
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I remember that UW has older age as a risk factor than mtb, maybe this is intermediate prob lesion, ex-smoker, lesion might be not >2 cm. Anyway i would go with u world in everything.
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Old 11-05-2013
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When u evaluate a pulmonary nodule, you should evaluate the morphology of the nodule very well.CT is best to evaluate such nodules and associated lesions.

After CT you can decide whether it is high probability or intermediate probability lesion
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Old 11-06-2013
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MTB says dont do sputum cytology, needle biopsy & PET scanning in high probability lesions, because it could give u false negative. But it doesn't say "don't do CT"

if u consider it a high probability lesion & decide 2 go wid thoracotomy, I think you would need a CT 2 guide u through d procedure. You cant blindly cut through the ribs trusting a X ray

If u consider this an intermediate probability lesion, You for sure need a CT 2 do bronchoscopy or needle biopsy.

so either way CT wins
feel free 2 correct me if I am wrong

Last edited by ddaydreamer; 11-06-2013 at 01:35 PM. Reason: Typo
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Old 11-08-2013
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So i came with that question and as i supposed size is <2cm, quite a long quitting history but main thing is:

The answer of ct scan does not mean the "serial ct monitoring of lesions"
Its simply means in this question Chest CT scan with contrast to determine probability high low or intermediate----> this is not evaluation CT. And given info is not sufficient to decide lesion is of what kinda probability thats why we do ct.
go back to explanation you will see what i am talking about just go through the first chart.
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