The pulmonologist's perspective regarding the solitary pulmonary nodule

The pulmonologist's goal in managing a patient with a solitary pulmonary nodule is to distinguish the benign from malignant nodule and, where malignancy is either confirmed or strongly suspected, to expedite resection. By using established clinical features (eg, age, smoking status) and radiographic findings (eg, calcification, growth rate, size), a probability of malignancy can be determined. If necessary, noninvasive or adjuvant invasive testing is used to alter the probability to one that permits observation or demands resection. The proper use of these tests mandates knowledge about their performance characteristics. Decision-analytic approaches, using Bayesian analysis, may assist with the calculation of probability. These models have not consistently outperformed the clinician or adjuvant testing. The use of low-dose computed tomography (CT) scanning as a screening tool has led to the discovery of many small, indeterminate nodules. Management decisions for these nodules are influenced by their low prevalence of malignancy and small size. Future advances will add to our ability to effectively meet our stated goal.