An Update on the Evaluation and Management of Small Pulmonary Nodules

Alexandre M Furman; Jihane Zaza Dit Yafawi; Ayman O Soubani


Future Oncol. 2013;9(6):855-865. 

In This Article

Clinical Factors in the Evaluation of Lung Nodules

Age is one of the most important, as well as independent, risk factors for malignancy.[15] Malignancy is an exceedingly rare cause of lung nodules in patients younger than 30 years with a probability for malignancy of <1%.[16,17] The probability increases with advancing age and approaches 88% in patients older than 70 years.[18,19]

Tobacco use (past or present) is another independent factor that predicts malignancy.[16,20,21] The risk increases with both quantity and duration of smoking.

Other exposures such as to radon gas, asbestos and certain metals (e.g., chromium, cadmium and arsenic) also increase the risk of malignancy.[16]

The history of any other malignancy, current or remote, also increases the probability of the nodule being malignant.[22,23] In a report, in patients with head and neck cancer, 70% of pulmonary nodules were due to primary lung cancer, 19% were due to a benign condition (commonly tuberculosis) and 9% were due to metastatic spread of the underlying cancer. In patients with melanoma, sarcoma and renal cell carcinoma, 60% were shown to be metastatic and 24% were primary lung cancer.[24] It is important to realize that without the underlying history of malignancy, a metastatic origin of the lung nodule is less likely and a routine search for an extrathoracic primary malignancy is not indicated.[21]

Other important clinical features include presence of hemoptysis, fever, constitutional symptoms and travel history. Infection with HIV increases the risk of lung cancer at a younger age.[25] Another important consideration should be given to the presence of underlying parenchymal lung disease. These include idiopathic pulmonary fibrosis, radiation and asbestosis, and must be considered as the etiology.