Murrell et al identified a number of factors which can help to identify a solitary lung nodule in a pediatric cancer patient that should be biopsied. The authors are from Cincinnati Children’s Hospital.
Patient selection: pediatric patient with solitary lung nodule and a history of cancer
Conditions associated with metastasis (and need for lung biopsy):
(1) peripheral lesion (odds ratio 9)
(2) location in the right lower lobe (odds ratio 2.4)
(3) diameter 0.5 to 1.0 cm (not < 0.5 or > 1.0, odds ratio 2.8)
(4) history of any of the following:
(4a) osteosarcoma (odds ratio 11)
(4b) Ewing sarcome (odds ratio 3)
(4c) hepatocellular carcinoma (odds ratio 2.4)
The likelihood of the nodule being a metastasis increases with the number of conditions met.
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