Diagnostic d'un nodule pulmonaire solitaire

The finding of a solitary pulmonary nodule is a frequent and difficult problem. Solitary nodules are caused by a variety of conditions, ranging from benign granulomas to lung cancer. Because solitary nodules are often primary bronchogenic carcinoma with only 5-yr survival after resection, it is important to promptly identify malignant nodules. The goals of management are to resect malignant tumors and to avoid unnecessary thoracotomy if the nodule is benign. Evaluation with thin-section CT is first necessary for detailed evaluation including lesion size, contour and edge, calcification and nodule density. When solitary nodule remains of indeterminate origin, the use of non-invasive techniques such as contrast-enhanced CT and positron emission tomography (PET), in detecting nodule enhancement is discussed. Growth rate is of importance in evaluating the nature of a solitary pulmonary nodule, 2-year stability is always considered an indicator of benignity. The Bayesian approach is based on the principles of decision analysis, its estimates the prevalence of malignancy in the population, assesses risk factors predictive of malignancy as demonstrated by history and chest radiograph, and selects a management strategy based on the adjusted probability of malignancy.