British Thoracic Society guidelines for the investigation and
management of pulmonary nodules
Tudor Toma, MD PhD,Consultant Respiratory Physician &
Honorary Clinical Senior Lecturer, University Hospital Lewisham -
Greenwich NHS Trust & King's College London.
British Thoracic Society guidelines for the investigation and
management of pulmonary nodulesVolume 70 Supplement 2 | THORAX
August 2015
Guideline Approach
Please give me some Advantages and disadvantages.
2
Guideline Approach
Advantages: everybody works the same, you do not need to be an
expert to be able to do the job, rapid solution in most of cases,
efficient use of resources.Disadvantages: complex cases may be
initially mismanaged.
3
How to work with a Guideline?
Advantages: everybody works the same, you do not need to be an
expert to be able to do the job, rapid solution in most of cases,
efficient use of resources.Disadvantages: complex cases may be
initially mismanaged.
Start rigid and loosen up latter.Work first like a machine and
then like an artist.These recommendations may not be appropriate
for use in all situations.Use clinical judgement, knowledge and
expertise.Start rigid and loosen up latter.
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So, what is the problem?Please guess if this nodule is malignant
or not?
We now know that from 20 nodules 1 is malignant. 5
Solution
Do a risk assessment on the basis of:Nodules CT
characteristicsClinical history
How do we solve the problem?
Answer the following questionsWhat type/density of nodule do you
see?What is the size of the nodule?What is the clinical risk of
malignancy?How frequently do you need to re-scan for
surveillance?Nodule grows or seems malignant. What to do next?How
should you organise your service?
Question 1What type/density of nodule do you see?
Question 2What is the size of the nodule?
Initial approach
Typical benign features hamartoma or perifisural nodes. 14
Question 3What is the clinical risk of malignancy?
Risk (guess) calculator
Question 4How frequently do you need to re-scan for
surveillance?
Solid nodule surveillance algorithm
Sub-solid nodule algorithm
Question 5Nodule grows or seems malignant. What to do next?
Nodule treatment algorithm
Question 6How should you organise your service?
Practical workflow
Your practiceAuditShareConnect & Network
ConclusionsFollow the guidelines!Standardise: Assessment of the
risk.Nodules monitoring approach.Consider CT guided biopsy vs.
surgery.Audit & evaluate your practice.Volume 70 Supplement 2 |
THORAX August 2015
