Solitary pulmonary nodule - morphology, evaluation and management. The challenge with the small nodule

During the previous years there has been accumulated new data about pulmonary carcinoma. That caused changes in classical understanding of more generalized topic, the solitary pulmonary nodule (SPN). A part of new data is being acquired in result of wide use of multidetector computed tomography (MDCT) and number of large screening trials for pulmonary carcinoma, where MDCT is the main diagnostic method. There is a new histological classification of pulmonary adenocarcinoma, also the recent revision of TNM staging. The increased spatial resolution of MDCT resulted in better visualization of small pulmonary nodules and to pursuit earlier diagnosis of pulmonary carcinoma. In the diagnosis of SPN the main question is - benign or malignant, the nodule we found? In this article we will try to present the new data concerning the malignant nodules and to introduce number of approaching algorithms. The use of different imaging modalities, as well as fine needle aspiration biopsy and core-biopsy in most of the cases can differentiate between benign and malignant lesions. The goal of diagnostic algorithms is to diagnose earlier malignant nodules, those that acquire active therapeutic approach and higher probability for radical treatment and to minimize unnecessary surgical interventions. (authors)