Evaluation and management of the solitary pulmonary nodule

The approach to the SPN involves a careful evaluation of the patient, beginning with a history and physical examination with particular attention to risk factors for malignancy. Old CXRs should be obtained and a CT scan is usually indicated if the nodule is not demonstrated to be stable for 2 yr or more. Additional imaging with CT with contrast infusion or PET, or both, may help to further define the nodule. An estimate of the probability of malignancy is then made and a strategy of observation, biopsy, or thoracotomy is chosen on the basis of the probability of malignancy, as well as an individual assessment of the patient. Future developments need to improve case finding techniques, to assess the impact of newer technologies on decision analysis, and to integrate this with the effect of new multimodality treatments for lung cancer.