Subsolid Pulmonary Nodules and the Spectrum of Peripheral Adenocarcinomas of the Lung: Recommended Interim Guidelines for Assessment and Management

Subsolid nodules are now known to frequently represent the histologic spectrum of peripheral adenocarcinomas including premalignant atypical adenomatous hyperplasia, bronchioloalveolar carcinoma and mixed subtype adenocarcinoma. Based on current knowledge, new guidelines are necessary for follow up and management of subsolid nodules on CT scans.

In a review article in the December issue of Radiology (RSNA.org/radiology), Myrna C.B. Godoy, M.D., and David P. Naidich, M.D., of New York University-Langone Medical Center, examine clinical, radiologic and pathologic aspects of subsolid pulmonary nodules and propose new interim management guidelines. Specifically, authors discuss:

Correlated coronal PET image shows FDG uptake (arrow) by the lesion in the left upper lobe (maximum standardized uptake value, 3.4). (Radiology 2009;297:2127-2141) © RSNA, 2009. All rights reserved. Printed with permission.

• Epidemiology and histopathologic classification of adenocarcinoma of the lung

• Peripheral adenocarcinoma: CT-pathologic correlations and prognosis

• Benign vs. malignant subsolid nodules: CT evaluation

• Current concepts in the diagnosis and management of subsolid nodules

• Growth rate of small peripheral adenocarcinomas in low-dose CT screening for lung cancer

• Methods for measuring interval change in the appearance of focal nodules

• Role of PET

• Role of transbronchial and transthoracic needle biopsy for diagnosis of BAC

• Surgical resection of small peripheral adenocarcinomas

• Current status and ongoing controversies in the management of subsolid lung nodules

"It is anticipated that future developments based on multidisciplinary efforts will result in greater consensus regarding optimal CT classification of subsolid lesions and ultimately more definitive, evidence-based guidelines leading to more rigorous standardization and ultimately improved clinical treatment of patients with subsolid lung nodules," the authors conclude.

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Thermal Ablation of Osteoid Osteoma: Overview and Step-by-Step Guide

Although osteoid osteoma—a small, benign but painful lesion with specific clinical and imaging characteristics—has traditionally been treated with surgery, the potentially serious complications have made percutaneous radiofrequency (RF) ablation an effective alternative.

Surgically inaccessible lesion. Axial and coronal CT images obtained in a 15-year-old girl demonstrate an osteoid osteoma in the left sacrum (arrow) with adjacent sclerosis and with narrowing of the left S2 neural foramen secondary to hyperostosis. Surgical access to a lesion in such close proximity to the nerve roots is a challenge. (RadioGraphics 2009;253:3:606-622) © RSNA, 2009. All rights reserved. Printed with permission.

In an article in the November-December issue of RadioGraphics (RSNA.org/radiographics), Daria Motamedi, M.D., of Cedars-Sinai Medical Center in Los Angeles, and colleagues summarize the indications and contraindications for RF ablation and offer a step-by-step guide for performing successful ablation. In addition, the authors discuss:

• Histologic and radiologic imaging characteristics

• Differential diagnosis

• Treatment options

• Special cases

• Complications

"RF ablation, which involves the use of thermal coagulation to induce necrosis in the lesion, is a minimally invasive alternative to surgical treatment of osteoid osteoma," the authors conclude. "With reported success rates approaching 90 percent, RF ablation should be considered among the primary options available for treating this condition."