What do you do with a case like this? It’s a 65 year, smoking history of 20 cigarettes a day for 30 years, that got a CT scan for other reason and a GGO spot was found in the left upper lobe. The nodule was sized in 1 cm and the doctor that saw the patient ordered a PET-CT that showed SUV of 5. Nothing lighted up in the mediastinum or elsewhere. Bronchoscopy was normal. FEV1 is 1.35 liters (50%) and DLCO 65%. He hasn’t any other significant health issue. The patient is not very anxious about this finding and he wants to know your suggestion. What are the options?
I guess you might try to stick a needle on it, but your radiologist should be very skilful to target this tiny spot in the middle of the lung, especially in a patient with emphysema. The risk of pneumothorax is significant.
What other options? Well, I don’t have any experience with navigational bronchoscopy, but if any has, it’ll be great to hear any input. The two other options I can think of are surgery or just wait. I’m not very keen on waiting in a case like this, but I accept somebody may have this as a suggestion. Surgery will take a lobectomy, as the spot is in the middle of the upper lobe and very close to a PA branch.
What do you think is the best option? Do you think you can take it out with a lesser resection than lobectomy?