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Airway nodules on lung cancer screening CT are not very

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common, but when they occur, it's important for us

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to recognize when they become actionable

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and when they simply represent evidence

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of underlying lung disease such as asthma

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or chronic bronchitis, different forms

0:15

of chronic obstructive pulmonary disease.

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We're gonna talk about the lung rads categories

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for airway nodules, which was first introduced

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with Lung RADS 2022,

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and the follow-up recommendations that come

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with that categorization.

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Another important feature to consider

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among airway nodules are things we're used

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to seeing every day on cha cts,

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which are secretions in the airway.

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When can you cause something secretions

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or moid impaction evidence of small area disease

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or when does it become an actionable nodule?

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So we'll look at some cases, about half a percent

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of lung cancer screening CT exams will have

0:53

an endo bronchial lesion.

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And by this I don't mean things

0:57

that we consider secretions when we look at them.

1:00

Over 96% of these do resolve on followup imaging,

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and most of them that don't are benign.

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But within this group, there are cancers

1:09

in the Dutch Belgian Nelson trial for lung cancer screening.

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22% of cancers missed on the initial screening

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or endobronchial.

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And by this I mean primarily segmental lobar

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and rarely distal trachea.

1:23

The category for lung rats of

1:25

where endobronchial nodules go in the schema are based on

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location morphology, the number of them,

1:32

and if they persist on followup cts.

1:36

Category zero, meaning we don't score it in lung rads,

1:39

are the typical findings of endobronchial secretions.

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They're often linear.

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If they're lumpy, they have little bits

1:45

of air mix within them, they look sort of frothy

1:48

or they may be branching in tubular.

1:51

We start to get into the lung rads numbering of two four A

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and four B with category two, an endobronchial nodule

1:58

that is a subsegmental airway nodule

2:01

or air within an airway nodule in the absence

2:04

of a soft tissue component

2:05

or mean attenuation less than 21 household units.

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This was the best way for us to describe things

2:11

that are probably secretions.

2:13

Therefore lung rads two negative screens,

2:16

but we will want to follow them on the next annual screening

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CT category four A.

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This is where we get concerned

2:23

and want to do interval follow-up is when we have a

2:26

segmental or proximal airway nodule without the benign

2:29

features of low density or air within them.

2:33

And for these, we recommend a three month low dose ct.

2:36

Typical of the four. A recommendation category

2:39

when we get most concerned are the nodules

2:41

that are in the four B category.

2:43

These are endobronchial nodules that are in segmental

2:45

or larger airways that are persisting on follow-up cts,

2:50

or grow over time.

2:52

These should be referred

2:53

for clinical evaluation and bronchoscopy.

2:56

One of the questions I commonly get about endobronchial

2:59

Nodules, is there anything we can do to prevent some

3:02

of these nodules from even showing up on our lung cancer

3:04

screening cts?

3:06

What I usually recommend is that our imaging technologists

3:09

who are acquiring the CT images, when the patient comes

3:12

for their exam, ask the patient to take several deep,

3:15

big coughs before they lay down on a scatter table.

3:19

This can help them clear small areas of secretions

3:22

that we won't have to see on the CT examinations

3:24

because of this simple intervention.

3:27

So a few good coughs

3:28

before laying down on the CT table can prevent you even

3:31

having some of these on your images to look at.