Indeterminate Pulmonary Nodule: An assessment from a Surgeon’s perspective

Abstract

Background: Finding of pulmonary nodule in chest X-ray or CT scan during routine investigations or during surveillance for metastasis, in known case of malignancy is not an uncommon occurrence. Even after all routine evaluation, if nature of such a pulmonary nodule cannot be characterized as either benign or malignant then it is termed as Indeterminate Pulmonary Nodule (IPN). Aim of this study is to put some light on the way to assess such IPN in simplified manner form a surgeon’s perspective so that the unnecessary surgery or morbidity and mortality associated with it can be avoided. Methods: For this article, extensive literature search was performed, using online search engine PubMed, Google, Cochrane database etc. Out of 474 articles, 42 Articles which fulfilled all the eligible criterion, were used for this study. Results: Most of the studies are in favour of evidence based, step mannered and pragmatic approach to evaluate the IPN. Foremost and most important step in course of evaluation of IPN is proper clinical evaluation and risk assessment in terms of pre-test probability of malignancy. Although morphological characterisation can be done with newer advance imaging techniques but the only way to confirm the malignancy is getting a tissue biopsy. Conclusions: With proper clinical evaluation, risk assessment analysis and prudent use of advance imaging techniques, a surgeon can prevent the morbidity and mortality associated with unnecessary surgery and other invasive interventions.