Distinguish Malignant vs. Benign Lung Nodules

Distinguishing between malignant and benign lung nodules on CT imaging is a critical task in clinical practice. Although it requires expertise and careful evaluation, there are some key features and considerations that can help differentiate between the two. Here are some factors to consider when analyzing lung nodules on CT imaging:

1. Size: Nodule size is an essential factor. Generally, larger nodules have a higher likelihood of being malignant, although there is no definitive size threshold to differentiate between benign and malignant nodules.

2. Shape: Nodule shape can provide valuable information. Benign nodules often have a polygonal, flat, or discoid shape.

3. Density: Nodule density refers to its attenuation on CT imaging. Nodules with ground-glass opacity (GGO) or a part-solid appearance tend to be more commonly associated with malignancy than solid lung nodules on a per-nodule basis, especially part-solid nodules with a solid component larger than 8-10 mm. However, solid lung nodules are more numerous than ground-glass or part-solid nodules.

4. Growth rate: Assessing the growth rate of nodules over time is crucial. Malignant nodules tend to show growth, benign nodules tend to have either a stable size, grow very quickly, or grow very slowly. Comparing current CT scans with prior imaging (if available) can help evaluate growth.

5. Calcification: The presence of calcification within a nodule can provide useful information. Popcorn-like or central calcification is typically associated with benign nodules. Conversely, eccentric or stippled calcification is more suggestive of malignancy.

6. Spiculation: Spiculation refers to the presence of thin hair-like projections extending from the nodule margin. It is more commonly seen in malignant nodules and indicates invasive growth into the surrounding lung tissue.

7. Other features: Additional factors that may help differentiate between benign and malignant nodules include the presence of satellite lesions (additional nodules in proximity), air bronchograms, and internal fat.

It's important to note that while these features provide valuable information, they are not definitive in determining the nature of a nodule. The final diagnosis often requires a multidisciplinary approach involving radiologists, pulmonologists, and oncologists. In many cases, further diagnostic procedures such as biopsy, PET-CT scans, or close follow-up imaging may be necessary to reach a conclusive diagnosis.

It is crucial to consult with a qualified healthcare professional or radiologist who can thoroughly evaluate the CT images and provide an accurate diagnosis based on the patient's clinical history and additional investigations.

Chapters:
00:00 - Introduction
00:20 - Size
03:28 - Air Bronchograms
04:07 - Cavitation
04:46 - Pseudocavitation
05:12 - Heterogeneity
05:34 - Sub-solid Density
06:00 - Internal Fat
06:14 - Calcification
07:38 - Polygonal Shape
07:50 - Flat/Discoid Shape
08:14 - Margin
09:25 - Cluster or Satellite Nodules
09:39 - Growth Rate
10:24 - Location
10:53 - Closing

#lungcancer #radiology #lungs

[denniskuo]

I'm a resident of radiology from Taiwan.
I want to thank you for these GREAT(greatest) lectures since i was searching lots of sources to learn.
These systematic approach really helps me a lot!!!

[joshuagerry]

Great presentation. Thank you. I learned more in this 11 minute video than in 2 hrs of lecture. Really high yield!

[radiologyframeworks]

Answering a question we sometimes encounter from radiology residents, referring providers, and laypersons…

The 4 main lung nodule margin categories are:

• SMOOTH: margin with no perceptible projections, bulges, lumps, or indentations. Although most lung nodules with smooth margins are benign, 20% of malignant nodules have smooth margins & most metastatic nodules are smooth.

• LOBULATED: at least one abrupt bulge in contour. Medium-high suspicion for malignancy.

• SPICULATED: radial & unbranched thin linear opacities extend orthogonally from nodule margin into surrounding lung parenchyma, without reaching pleural surface. Very high suspicion for malignancy.

• IRREGULAR: margin that isn’t smooth, lobulated, or spiculated. Indeterminate for benign vs. malignant.

It can sometimes be challenging to distinguish whether a lung nodule margin is spiculated or irregular. Chest radiologists who specialize in lung cancer and other lung diseases (and publish a lot of the literature on lung nodules, their imaging, and outcomes) tend to be pretty rigorous and seasoned when making this distinction, and generally make this distinction with lower inter-reader variability.

In practices where the distinction between “spiculated” and “irregular” is handled more liberally however, the predictive value of the term “spiculated” for malignancy may sometimes, as one might expect, differ from what is reported in medical research literature, published in textbooks, and traditionally taught in radiology residency.

[Peaceful-hiiy]

I have had a history of benign lung nodules I. Recently, i had a preoperative screening CT scan and they found a new 15 mm nodule left lower lobe. The radiologist report says favor inflammatory or infectious process. I have had many bouts of pneumonia and flu. I also have had sepsis once. I also suffer from rheumatoid arthritis. I have never smoked. I have no family history of lung cancer. A CT scan or pet scan was recommended in 3 months. I'm truly nervous about the size of this one. Your video has helped me to understand very much. I'm hoping I'm okay

[A-Lagos]

2nd year Rad res and this was such a concise high yield review. Thank you!

[bookbeing]

I wish there was a standard for radiology reports that included your standards listed here. I have yet to see such well written informed imaging studies in my health history that is packed with fragmented substandard reports. Good imaging technologists are 💎💫🌟

I hate it when a report doesn't inform. My last one had two lines of text. Lung nodules. No specifics regarding size, count, shape, content, characteristics. Patients often spend weeks gridlocked in insurance imposed hoops then wait weeks for an appointment. One study took eight months for an appointment!

[jodybogdanovich]

I have PsA and developed shortness of breath and low oxygen sats so was referred to Pulmonology. A high-resolution CT showed findings consistent with bronchiolitis obliterans. Incidentally noted was a 5-mm solid nodule. A followup CT 1 year later showed the nodule was down to 3 mm, so I was relieved. However, a couple months later, the report was amended to show the nodule was still 5 mm. I am listed as high risk for malignancy because of my use of biologics and I'm assuming my age of 68. I will be having another high-resolution CT in May. My question is can a nodule remain stable for a few years but then go on to become a cancer?

[sung-hoshin]

I love this video! It will be super helpful for my research to look into the lung mets. Thanks a lot :)

[pamreynolds]

I had a small nodule removed during heart surgery small wedge it turned out to be adnocarcinoma why arent my nodules 7ml not being looked it went from 4 to 7 i just do not understand

[chrisgustafson]

Had influenza A in January that then became atypical pneumonia. As of April, still had an LUL GGO possibly 22mm, and concerningly to me, a new 6mm nodule with four less-than 4mm nodules in LLL. I live in North Central WI which is an endemic area for Blastomycosis. Next CT in beginning of July. If nodules are larger FDG-PET is next and possibly robtic brochoscopy & sputum cytology for aspergilliosis & blastomycosis. Very worried I have Adenocarcinoma because I'm an 80pk-yr smoker

[SuperSnake]

I had RCC T1A Grade 2 at age 37. They just discovered a nodule on X Ray on the upper lobe of my left lung. Going in for a CT tomorrow and I am hopeful it’s not what it could be. I am confused about the risk to patients who have been NED for years vs patients with active disease.

[Stella]

Can you create a video explaining lung nodules and their risk of malignancy for patients? I have 8 solid lung nodules, all measuring 6mm and smaller, located in the right lung. Stable on 6 month’s scan. One of these nodules is 6mm in size and spiculated. When I researched spiculated nodules, I learned that they are almost always malignant, with a predictive value of up to 90%. I also came across your comment on here stating that even small spiculated nodules are almost always malignant. So, regardless of their small size, spiculated nodules seem to consistently indicate malignancy.
I'm confused as to why doctors still recommend a watch and wait approach when spiculation is such a certain indicator of malignancy. My doctor couldn't provide me with clear answers. He did mention that spiculation, along with other nodules, can sometimes be caused by infection or inflammation. This conflicting information is making it difficult to make a decision. I don't want to hold onto false hope. Should I take a more proactive approach in my case?

[romsa]

Thank you very much for your videos! Could you please tell me where the information about calcification patterns comes from? In our country, amorphous calcification is considered to be a benign sign.

[marypennington]

Have a nodule one is 8mil an no body told me had covig 2020 an alot colds copd quick patches are not cover under my insurance nicotine patch does increase chance it will go it round tail on it radiation therapy target area an schink it what chanes of me didnt want biosy want secons opinion on it

[maninthebox]

I have a 6mm nodule is my posterior basilar lower right lobe but it doesn’t say anything about it being anywhere near the pleura. I’m supposed to go for CT scans every 6-12 mos for a bit to monitor it.

[hasanulusoy]

Highly usesul presentation, thank you sir 👏👏👏👏

[Darwin_]

Ct scan showed 5 solid lung nodules between 4-5mm in size
2 are calcified granuloma, 2 are perifisual
1 nodule is Spiculated.
After doing some research, it seems most likely that the Spiculated nodule is malignant.
how often do you have cases of Spiculated lung nodules that turn out to be benign? Do such cases occur often or are they really that rare?

[timmaglicco]

My ct scan with contrast stated findings of stable 3mm lower right lower lobe . They did the scan because I had viral covid pneumonia. My question is I’m wonder why they used that word stable ? Ty

[brianwillow]

I have a lower right pulmonary lung nodule. In march of 2018 it was 2mm and now it’s 9mm……. Its round. I go for follow up CT scan next month. Is this big or small? Does growth automatically mean cancer? I’m 40 and smoked throughout my 20’s

[Foxy-elpk]

I had a CT and shows I have a 2mm lower left lobe nodule. I'm 39 and vape heavily.

Since April 2024 I've had bronchitis twice and pneumonia.

August 2024 CT showed lungs were clear but found 2mm nodule.
I've only had this cough for 4 months and actually vaping less in that time.
But my cough won't go away.

Do lung nodules make you cough?

I'm waiting for appointment with respiratory specialist.