Criteria of Batra et al for Identifying the Nature of a Pulmonary Opacity on Chest Radiographs

Batra et al listed features of a pulmonary parenchymal nodule seen on a chest X-ray that would help identify it as benign or malignant.

Parameter	Probably Benign	Indeterminate or Noncontributory	Probably Malignant
diameter	< 2 cm	2 – 3 cm	> 3 cm
margins	well-circumscribed	smooth	spiculated
calcifications	benign pattern (see below)	none, or eccentric	often noncalcified
age	stable for 2 years	unknown	increasing in size
doubling time	< 30 days or 490 days	unknown	30 – 490 days
cavity	thin walls (< 4 mm) and/or air-fluid level		may be cavitated
other	nearby satellite lesions

Calcification patterns seen in benign lesions:

(1) granulomas: dense central, diffuse or laminated

(2) hamartoma: "popcorn"

Calcifications in malignant tumors:

(1) Eccentric calcifications may be present if the tumor engulfs a calcified granuloma.

(2) Some primary lung carcinomas may show subtle calcifications.

(3) Some metastatic tumors (osteogenic sarcoma, thyroid carcinoma, breast, GI tract) may calcify.

To calculate the doubling time:

doubling time in days =

= ((initial diameter in cm) * (days between films)) / ((second diameter in cm) – (initial diameter in cm))

which can be calculated from the straight line equation, with:

• intercept = (initial diameter)

• slope = ((second diameter) – (initial diameter)) / (days between)

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