Solitary pulmonary nodule: A bayesian approach

One of the frequent problems encountered by pulmonary physicians, the workup of a solitary pulmonary nodule (SPN), is marred by subjectivity and uncertainty. The decision to remove a potentially curable malignant lesion is dependent on a multitude of radiographic and clinical variables, as is the decision to prospectively observe a potentially benign nodule. Physicians often err because there are too many variables to incorporate into the decision-making. This article reviews the current concepts in the evaluation of SPNs. Radiologic appearance (size, shape, calcification, and growth rate) and clinical characteristics (age, smoking, prior history of malignancy, and symptoms) used in differentiating benign from malignant SPNs are reviewed. Bayesian analysis, an objective approach incorporating the relative-risks of each variable, is discussed. We propose that by incorporating this approach into an algorithm, the workup of SPNs can be more objective and cost- efficient.