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CC BY-NC-ND 4.0 · Avicenna J Med 2011; 01(02): 39-51
DOI: 10.4103/2231-0770.90915
REVIEW ARTICLE

Solitary pulmonary nodule: A diagnostic algorithm in the light of current imaging technique

Ali Nawaz Khan
North Manchester General Hospital, Pennine Acute NHS Trust, Manchester, UK
,
Hamdan H Al-Jahdali
King Saud University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
,
Klaus L Irion
The Cardiothoracic Centre Liverpool NHS Trust, The Royal Liverpool University Hospital, UK
,
Mohammad Arabi
The University of Michigan Health System, Ann Arbor, MI, USA
,
Shyam Sunder Koteyar
North Manchester General Hospital, Pennine Acute NHS Trust, Manchester, UK
› Author Affiliations Source of Support Nil.
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Abstract

The solitary pulmonary nodule (SPN) is frequently seen on chest radiographs and computed tomography (CT). The finding of a SPN usually provokes a flurry of clinical and imaging activity as an SPN in at-risk population is an alert signal of possible lung cancer. The frequency of malignant nodules in a given population is variable and depends on the endemicity of granulomatous disease. The percentage of malignant nodules also rises when dealing with at-risk population. The problem is compounded by the fact that with the present generation of CT scanners, 1-2 mm nodules are discovered in approximately half of the smokers aged 50 years or older scanned. A variety of management approaches are applied in the work-up of SPN often requiring evaluation over a long period of time to establish a benign or malignant diagnosis. Comparison with previous imaging studies and morphologic evaluation of the size, margins, and internal characteristics are usually the first step in the evaluation of these nodules. It is often necessary to use additional imaging techniques and occasionally invasive procedures such a percutaneous needle lung or a surgical biopsy. Until recently, the guidelines for follow-up of indeterminate noncalcified nodules detected on nonscreening CT was a minimum of 2 years. However, during the past few years due to further refinements in CT technology and better understanding of tumor behavior, it has prompted a revision of the guidelines of the follow-up of small indeterminate nodules. These guidelines have been endorsed by the Fleischner Society.

Keywords

Benign lung nodules - CT - lung cancer - PET/CT - pulmonary nodules


Publication History

Article published online:
09 August 2021

© 2011. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008;246:697-722.
  • 2 Holin SN, Dwork RE, Glaser S, Rikli AE, Stocklen JB. Solitary pulmonary nodules found in a community-wide chest roentgenographic survey; a five-year follow-up study. Am Rev Tuberc1959:79:427-39.
  • 3 Swensen SJ, Jett JR, Hartman TE, Midthun DE, Sloan JA, Sykes AM, et al. Lung cancer screening with CT: Mayo Clinic experience. Radiology 2003:226:756-61.
  • 4 Gohagan J, Marcus P, Fagerstrom R, Pinsky P, Kramer B, Prorok P; Writing Committee, Lung Screening Study Research Group. Baseline findings of a randomized feasibility trial of lung cancer screening with spiral CT scan vs chest radiograph: the Lung Screening Study of the National Cancer Institute. Chest 2004:12:114-21.
  • 5 International Early Lung Cancer Action Program Investigators, Henschke CI, Yankelevitz DF, Libby DM, Pasmantier MW, Smith JP, et al. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med 2006;355:1763-71.
  • 6 Gould MK, Fletcher J, Iannettoni MD, Lynch WR, Midthun DE, Naidich DP, et al. Evaluation of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines 2 nd ed. Chest 2007:132(3 suppl):108S-130S.
  • 7 Midthun DE, Swensen SJ, Jett JR. Approach to the solitary pulmonary nodule. Mayo Clin Proc1993:68:378-85.
  • 8 Takashima S, Sone S, Li F, Maruyama Y, Hasegawa M, Matsushita T, et al. Small solitary pulmonary nodules (< or =1 cm) detected at population-based CT screening for lung cancer: Reliable high-resolution CT features of benign lesions. AJR Am J Roentgenol 2003:180:955-64.
  • 9 Tozaki M, Ichiba N, Fukuda K.Dynamic magnetic resonance imaging of solitary pulmonary nodules: utility of kinetic patterns in differential diagnosis. J Comput Assist Tomogr 2005:29:13-9.
  • 10 Wahidi MM, Govert JA, Goudar RK, Gould MK, McCrory DC; American College of Chest Physicians. Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines 2 nd ed. Chest 2007:132(3 suppl):94S-107S.
  • 11 Tan BB, Flaherty KR, Kazerooni EA, Iannettoni MD; American College of Chest Physicians. The solitary pulmonary nodule. Chest 2003;123 (1 Suppl):89S-96S.
  • 12 Ost D, Fein AM, Feinsilver SH. Clinical practice. The solitary pulmonary nodule. N Engl J Med 2003;348:2535-42.
  • 13 Henschke CI, McCauley DI, Yankelevitz DF, Naidich DP, McGuinness G, Miettinen OS, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 1999;354:99-105.
  • 14 Henschke CI, Naidich DP, Yankelevitz DF, McGuinness G, McCauley DI, Smith JP, et al. Early lung cancer action project: initial findings on repeat screenings. Cancer 2001;92:153-9.
  • 15 U.S. Department of Health and Human Services. The health consequences of smoking: a report of the surgeon general. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health ; 1982.
  • 16 Guyatt GH, Newhouse MT. Are active and passive smoking harmful? Determination causation. Chest 1985;88:445-1.
  • 17 Mayne ST, Buenconsejo J, Janerich D. Familial cancer history and lung cancer risk in United States nonsmoking men and women. Cancer Epidemiol Biomarkers Prev 1999;8:1065-9.
  • 18 Bailey-Wilson JE, Amos CI, Pinney SM, Petersen GM, de Andrade M, Wiest JS, et al. A major lung cancer susceptibility locus maps to chromosome 6q2325. Am J Hum Genet 2004;75:460-74.
  • 19 Gottlieb LS, Husen LA. Lung cancer among Navajo uranium miners. Chest 1982;81:449-52.
  • 20 Field RW, Steck DJ, Smith BJ, Brus CP, Fisher EL, Neuberger JS, et al. Residential radon gas exposure and lung cancer: the Iowa Radon Lung Cancer Study. Am J Epidemiol 2000;151:1091-102.
  • 21 Lee PN. Relation between exposure to asbestos and smoking jointly and the risk of lung cancer. Occup Environ Med 2001;58:145-53.
  • 22 Revel MP, Lefort C, Bissery A, Bienvenu M, Aycard L, Chatellier G, et al. Pulmonary nodules: preliminary experience with three-dimensional evaluation. Radiology 2004;231:459-66.
  • 23 Revel MP, Bissery A, Bienvenu M, Aycard L, Lefort C, Frija G. Are two-dimensional CT measurements of small noncalcified pulmonary nodules reliable? Radiology 2004;231:453-8.
  • 24 Yankelevitz DF, Gupta R, Zhao B, Henschke CI. Small pulmonary nodules: evaluation with repeat CT-preliminary experience. Radiology 1999;212:561-6.
  • 25 Henschke CI, Yankelevitz DF, Naidich DP, McCauley DI, McGuinness G, Libby DM, et al. CT screening for lung cancer: suspiciousness of nodules according to size on baseline scans.Radiology2004;231:164-8.
  • 26 Holin SM, Dwork RE, Glaser S, Rikli AE, Stocklen JB. Solitary pulmonary nodules found in a community-wide chest roentgenographic survey; a five-year follow-up study. Am Rev Tuberc 1959;79:427-39.
  • 27 Gurney JW. Determining the likelihood of malignancy in solitary pulmonary nodules with Bayesian analysis. Part I. Theory. Radiology 1993;186:405-13.
  • 28 Sone S, Tsushima K, Yoshida K, Hamanaka K, Hanaoka T, Kondo R. Pulmonary nodules: Preliminary experience with semiautomated volumetric evaluation by CT stratum. Acad Radiol 2010;17:900-11.
  • 29 Grewal RG, Austin JH. CT demonstration of calcification in carcinoma of the lung. J Comput Assist Tomogr 1994;18:867-71.
  • 30 Ledor K, Fish B, Chaise L, Ledor S. CT diagnosis of pulmonary hamartomas. J Comput Tomogr 1981;5:343-4.
  • 31 Siegelman SS, Khouri NF, Scott WW Jr, Leo FP, Hamper UM, Fishman EK, et al. Pulmonary hamartoma: CT findings. Radiology 1986;160:313-7.
  • 32 Mahoney MC, Shipley RT, Corcoran HL, Dickson BA. CT demonstration of calcification in carcinoma of the lung. AJR Am J Roentgenol 1990;154:255-8.
  • 33 Oldham HN, Jr, Young WG, Jr, Sealy WC. Hamartoma of the lung. J Thorac Cardiovasc Surg 1967;53:735-42.
  • 34 Khan AN, Al-Jahdali HH, Allen CM, Irion KL, Al Ghanem S, Koteyar SS. The calcified lung nodule: What does it mean? Ann Thorac Med 2010;5:67-79.
  • 35 Caskey CI, Templeton PA, Zerhouni EA. Current evaluation of the solitary pulmonary nodule. Radiol Clin North Am 1990;28:511-20.
  • 36 Kanauchi T, Hoshi T, Kato A. CT findings of pulmonary hamartoma with special reference to epithelial-lined clefts and connection with pulmonary arteries. Nippon Igaku Hoshasen Gakkai Zasshi 2004;64:300-4.
  • 37 Park KY, Kim SJ, Noh TW, Cho SH, Lee DY, Paik HC, et al. Diagnostic efficacy and characteristic features of MRI in pulmonary hamartoma: comparison with CT, MRI and pathology. J Comput Assist Tomogr 2008;32:919-25.
  • 38 Lien YC, Hsu HS, Li WY, Wu YC, Hsu WH, Wang LS, et al. Pulmonary hamartoma. J Chin Med Assoc 2004;67:21-6.
  • 39 Zakharov V, Schinstine M. Hamartoma of the lung. Diagn Cytopathol 2008;36:331-2.
  • 40 Jin MS, Ha HJ, Baek HJ, Lee JC, Koh JS. Adenomyomatoushamartoma of lung mimicking benign mucinous tumor in fine needle aspiration biopsy: a case report. Acta Cytol 2008;52:357-60.
  • 41 Wood B, Swarbrick N, Frost F. Diagnosis of pulmonary hamartoma by fine needle biopsy. Acta Cytol 2008;52:412-7.
  • 42 Guo W, Zhao YP, Jiang YG, Wang RW, Ma Z. Surgical treatment and outcome of pulmonary hamartoma: Retrospective study of 20-year experience. J Exp Clin Cancer Res 2008;27:8.
  • 43 De Cicco C, Bellomi M, Bartolomei M, Carbone G, Pelosi G, Veronesi G, et al. Imaging of lung hamartomas by multidetector computed tomography and positron emission tomography. Ann Thorac Surg 2008;86:1769-72.
  • 44 Garland LH, Coulson W, Wollin E. The rate of growth and apparent duration of untreated primary bronchial carcinoma. Cancer 1963;16:694-707.
  • 45 Schultz EM, Silvestri GA, Gould MK. Variation in experts′ beliefs about lung cancer growth, progression, and prognosis. J Thorac Oncol 2008;3:422-6.
  • 46 Collins VP, Loeffler RK, Tivey H. Observations on growth rates of human tumors. Am J Roentgenol Radium Ther Nucl Med 1956;76:988-1000.
  • 47 Nathan MH, Collins VP, Adams RA. Differentiation of benign and malignant pulmonary nodules by growth rate. Radiology1962;79:221-32.
  • 48 Dunnick NR, Parker BR, Castellino RA. Rapid onset of pulmonary infiltration due to histiocytic lymphoma. Radiology 1976;118:281-5.
  • 49 Erasmus JJ, Connolly JE, McAdams HP, Roggli VL. Solitary pulmonary nodules: Part I. Morphologic evaluation for differentiation of benign and malignant lesions. Radiographics 2000;20:43-58.
  • 50 Hood RT Jr, Good CA, Clagett OT, MCdonald JR. Solitary circumscribed lesions of the lung; study of 156 cases in which resection was performed. J Am Med Assoc1953;152:1185-91.
  • 51 Quint LE, Cheng J, Schipper M, Chang AC, Kalemkerian G. Lung lesion doubling times: values and variability based on method of volume determination. Clin Radiol2008;63:41-8.
  • 52 Good CA, Wilson TW. The solitary circumscribed pulmonary nodule; study of seven hundred five cases encountered roentgenologically in a period of three and one-half years. J Am Med Assoc 1958;166:210-5.
  • 53 Good CA, Hood RT Jr, McDonald JR. Significance of a solitary mass in the lung. Am J Roentgenol Radium Ther Nucl Med 1953;70:543-54.
  • 54 Yankelevitz DF, Henschke CI. Does 2-year stability imply that pulmonary nodules are benign? AJR Am J Roentgenol 1997;168:325-8.
  • 55 Libby DM, Henschke CI, Yankelevitz DF. The solitary pulmonary nodule: update 1995. Am J Med 1995;99:491-6.
  • 56 Scholten ET, Kreel L. Distribution of lung metastases in the axial plane. A combined radiological-pathological study. Radiol Clin (Basel) 1977;46:248-65.
  • 57 Bankoff MS, McEniff NJ, Bhadelia RA, Garcia-Moliner M, Daly BD. Prevalence of pathologically proven intrapulmonary lymph nodes and their appearance on CT. AJR Am J Roentgenol 1996;167:629-30.
  • 58 Zwirewich CV, Vedal S, Miller RR, Müller NL. Solitary pulmonary nodule: high-resolution CT and radiologic-pathologic correlation. Radiology1991;179:469-76.
  • 59 Hirakata K, Nakata H, Haratake J. Appearance of pulmonary metastases on high-resolution CT scans: comparison with histopathologic findings from autopsy specimens. AJR Am J Roentgenol 1993;161:37-43.
  • 60 Gaeta M, Pandolfo I, Volta S, Russi EG, Bartiromo G, Girone G, et al. Bronchus sign on CT in peripheral carcinoma of the lung: value in predicting results of transbronchial biopsy. AJR Am J Roentgenol 1991;157:1181-5.
  • 61 Naidich DP, Webb WR, Muller NL, Vlahos I, Krinsky GA. Focal lung disease, in Computed Tomography and Magnetic Resonance of the Thorax. 3 rd ed. Philadelphia, PA: Lippincott-Raven; 1999. p. 296-329.
  • 62 O′keefe ME Jr, Good CA, MCdonald JR. Calcification in solitary nodules of the lung. Am J Roentgenol Radium Ther Nucl Med 1957;77:1023-33.
  • 63 Görich J, Gamroth A, Beyer-Enke S, Kayser K, van Kaick G. Differential computed tomographic diagnosis of cavity-forming space-occupying lesions of the lung. Rofo1987;147:479-85.
  • 64 Miura H, Taira O, Hiraguri S, Hagiwara M, Kato H. Cavitating adenocarcinoma of the lung. Ann ThoracCardiovascSurg 1998;4:154-8.
  • 65 Siegelman SS, Zerhouni EA, Leo FP, Khouri NF, Stitik FP. CT of the solitary pulmonary nodule. AJR Am J Roentgenol 1980;135:1-13.
  • 66 Zerhouni EA, Spivey JF, Morgan RH, Leo FP, Stitik FP, Siegelman SS. Factors influencing quantitative CT measurements of solitary pulmonary nodules. J Comput Assist Tomogr 1982;6:1075-87.
  • 67 Xu DM, van Klaveren RJ, de Bock GH, Leusveld AL, Dorrius MD, Zhao Y, et al. Role of baseline nodule density and changes in density and nodule features in the discrimination between benign and malignant solid indeterminate pulmonary nodules. Eur J Radiol 2009;70:492-8.
  • 68 Henschke CI, Yankelevitz DF, Mirtcheva R, McGuinness G, Available from: http://www.ncbi.nlm.nih.gov/...........Miettinen OS; ELCAP Group. CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. AJR Am J Roentgenol 2002;178:1053-7. [Last accessed on 2011 Aug 29].
  • 69 Lee HJ, Goo JM, Lee CH, Yoo CG, Kim YT, Im JG. Nodular ground-glass opacities on thin-section CT: size change during follow-up and pathological results. Korean J Radiol 2007;8:22-31.
  • 70 Swensen SJ, Brown LR, Colby TV, Weaver AL. Pulmonary nodules: CT evaluation of enhancement with iodinated contrast material. Radiology1995;194:393-8.
  • 71 Potente G, Iacari V, Caimi M. The challenge of solitary pulmonary nodules: HRCT evaluation. Comput Med Imaging Graph 1997;21:39-46.
  • 72 Zhang M, Kono M. Solitary pulmonary nodules: evaluation of blood flow patterns with dynamic CT. Radiology1997;205:471-8.
  • 73 Yi CA, Lee KS, Kim EA, Han J, Kim H, Kwon OJ, et al. Solitary pulmonary nodules: dynamic enhanced multi-detector row CT study and comparison with vascular endothelial growth factor and microvessel density. Radiology2004;233:191-9
  • 74 Jeong YJ, Lee KS, Jeong SY, Chung MJ, Shim SS, Kim H, et al. Solitary pulmonary nodule: characterization with combined wash-in and washout features at dynamic multi-detector row CT. Radiology 2005;237:675-83.
  • 75 Bayraktaroglu S, Savaº R, Basoglu OK, Cakan A, Mogulkoc N, Cagirici U, et al . Dynamic computed tomography in solitary pulmonary nodules. J Comput Assist Tomogr 2008;32:222-7.
  • 76 Jiang NC, Han P, Zhou CK, Zheng JL, Shi HS, Xiao J. Dynamic enhancement patterns of solitary pulmonary nodules at multi-detector row CT and correlation with vascular endothelial growth factor and microvessel density. Ai Zheng 2009;28:164-9.
  • 77 Lee KS, Yi CA, Jeong SY, Jeong YJ, Kim S, Chung MJ, et al. Solid or partly solid solitary pulmonary nodules: their characterization using contrast wash-in and morphologic features at helical CT. Chest 2007;131:1516-25.
  • 78 Schaefer JF, Vollmar J, Schick F, Vonthein R, Seemann MD, Aebert H, et al. Solitary pulmonary nodules: dynamic contrast enhanced MR imaging - perfusion differences in malignant and benign lesions. Radiology 2004;232:544-53.
  • 79 Zou Y, Zhang M, Wang Q, Shang D, Wang L, Yu G. Quantitative investigation of solitary pulmonary nodules: dynamic contrast-enhanced MRI and histopathologic analysis. AJR Am J Roentgenol2008;191:252-9.
  • 80 Gaeta M, Russi EG, La Spada F, Barone M, Casablanca G, Pandolfo I. Small bronchogenic carcinomas presenting as solitary pulmonary nodules. Bioptic approach guided by CT-positive bronchus sign. Chest 1992;102:1167-70.
  • 81 Naidich DP, Sussman R, Kutcher WL, Aranda CP, Garay SM, Ettenger NA. Solitary pulmonary nodules. CT-bronchoscopic correlation. Chest 1988;93:595-8.
  • 82 Zacharopoulos G, Adam A, Ind PW. The positive bronchus sign in patients with known lung cancer. Eur J Radiol 1990;10:130-3.
  • 83 Gaeta M, Pandolfo I, Volta S, Russi EG, Bartiromo G, Girone G, et al. Bronchus sign on CT in peripheral carcinoma of the lung: value in predicting results of transbronchial biopsy. AJR Am J Roentgenol 1991;157:1181-5.
  • 84 Singh SP. The positive bronchus sign. Radiology1998;209:251-2.
  • 85 Kuhlman JE, Fishman EK, Siegelman SS. Invasive pulmonary aspergillosis in acute leukemia: characteristic findings on CT, the CT halo sign, and the role of CT in early diagnosis. Radiology 1985;157:611-4.
  • 86 Kuhlman JE, Fishman EK, Burch PA, Karp JE, Zerhouni EA, Siegelman SS. Invasive pulmonary aspergillosis in acute leukemia. The contribution of CT to early diagnosis and aggressive management. Chest 1987;92:95-9.
  • 87 Primack SL, Hartman TE, Lee KS, Müller NL. Pulmonary nodules and the CT halo sign. Radiology 1994;190:513-5.
  • 88 Mori M, Galvin JR, Barloon TJ, Gingrich RD, Stanford W. Fungal pulmonary infections after bone marrow transplantation: evaluation with radiography and CT. Radiology 1991;178:721-6.
  • 89 Lee YR, Choi YW, Lee KJ, Jeon SC, Park CK, Heo JN. CT halo sign: the spectrum of pulmonary diseases. Br J Radiol 2005;78:862-5.
  • 90 Parrón M, Torres I, Pardo M, Morales C, Navarro M, Martínez-Schmizcraft M. The halo sign in computed tomography images: differential diagnosis and correlation with pathology findings. Arch Bronconeumol 2008;44:386-92.
  • 91 Kuhlman JE, Fishman EK, Teigen C. Pulmonary septic emboli: diagnosis with CT. Radiology 1990;174:211-3.
  • 92 Milne EN, Zerhouni EA. Blood supply of pulmonary metastases. J Thorac Imaging 1987;2:15-23.
  • 93 Meziane MA, Hruban RH, Zerhouni EA, Wheeler PS, Khouri NF, Fishman EK, et al. High resolution CT of the lung parenchyma with pathologic correlation. Radiographics 1988;8:27-54
  • 94 Hirakata K, Nakata H, Nakagawa T. CT of pulmonary metastases with pathological correlation. Semin Ultrasound CT MR 1995;16:379-94.
  • 95 Hirakata K, Nakata H, Haratake J. Appearance of pulmonary metastases on high-resolution CT scans: comparison with histopathologic findings from autopsy specimens. AJR Am J Roentgenol 1993;161:37-43.
  • 96 Dodd JD, Souza CA, Müller NL. High-resolution MDCT of pulmonary septic embolism: evaluation of the feeding vessel sign. AJR Am J Roentgenol 2006;187:623-9.
  • 97 Lee SJ, Cha SI, Kim CH, Park JY, Jung TH, Jeon KN, et al. Septic pulmonary embolism in Korea: Microbiology, clinicoradiologic features, and treatment outcome. J Infect 2007;54:230-4.
  • 98 Jeong YJ, Yi CA, Lee KS. Solitary pulmonary nodules: detection, characterization, and guidance for further diagnostic workup and treatment. AJR Am J Roentgenol 2007;188:57-68.
  • 99 Brenner DJ. Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer. Radiology 2004;231:440-5.
  • 100 MacMahon H, Austin JH, Gamsu G, Herold CJ, Jett JR, Naidich DP, et al. Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology 2005;237:395-400.
  • 101 Swensen SJ. CTscreening for lung cancer. AJR Am J Roentgenol 2002;179:833-6.
  • 102 Rohren EM, Turkington TG, Coleman RE. Clinical applications of PET in oncology. Radiology 2004;231:305-32.
  • 103 Yamagami T, Iida S, Kato T, Tanaka O, Nishimura T. Combining fine-needle aspiration and core biopsy under CT fluoroscopy guidance: a better way to treat patients with lung nodules? AJR Am J Roentgenol 2003;180:811-5.
  • 104 Suzuki K, Nagai K, Yoshida J, Ohmatsu H, Takahashi K, Nishimura M, et al. Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules. Chest 1999;115:563-8.
  • 105 Jones YM, Irion KL, Holemans JA. A review of the imaging and clinical management of solitary pulmonary nodules. Imaging 2008;20:303-11.