0:00

Let's take a look at this screening CT

0:02

and a 62-year-old man with a 40 pack year history of smoking

0:06

who currently engages in cigarette smoking.

0:10

Very important as a radiologist in practice to

0:14

involve patients in smoking cessation activities when they

0:17

come for lung cancer screening

0:18

as an important touch touchpoint in the radiology department

0:23

for potential tobacco consultation cessation.

0:27

So as we're scrolling through this exam, we can see a bunch

0:30

of little tiny low density holes with no walls.

0:33

So some mild central lobular emphysema

0:35

and an occasional little micro nodule.

0:38

One right here anteriorly in the right upper lobe.

0:41

Another one up here, anteriorly left upper lobe.

0:44

So a number of these sub centimeter, four millimeter,

0:47

two millimeter nodules,

0:48

which will all be lung rads category two screens.

0:52

We're seeing some small airway wall thickening

0:55

with small airway lumens.

0:57

This person has airway predominant COPD

1:00

with extensive wall thickening,

1:02

but now we're coming into a lesion in the right upper lobe.

1:06

It has solid components. Let's blow this up a little bit.

1:10

It has solid components,

1:14

but it also has cystic components,

1:17

several cystic components.

1:18

So this is a mixed nodule with cystic and solid components.

1:23

The overall size of this lesion was 28

1:26

by 24 millimeters when it was measured.

1:29

I think some of the AI tools can have difficulty measuring

1:32

lesions that are this complex.

1:34

They might only measure the solid component

1:37

and think of the cystic component

1:39

because it's eccentric as maybe just emphysema

1:41

and not included in the overall cyst size.

1:44

So some of these more complex ones, it's important

1:46

to maybe do your own hand measurements,

1:49

look at it in three dimensions

1:51

because they can be irregular in shape

1:54

and every lung cancer is not a perfect round sphere.

1:59

It can be ovoid. They can certainly have different sizes

2:02

in different diameter.

2:03

So if we look at this here in the coronal images,

2:07

you can see it's wider than it is tall.

2:10

So sometimes you wanna measure it in the coronal sagal axial

2:14

plane to find the largest um area.

2:16

In a nodule like this,

2:18

you also wanna measure the largest solid component in

2:21

addition to measuring the overall size of the lesion.

2:24

So because of the complex nature with a combination of cys

2:27

and solid nodules, this would be a long rats four B lesion.

2:32

And you would get there whether you either came at it from a

2:35

solid nodule recommendation

2:37

or whether you came at it

2:38

through the cystic nodule recommendation schema, both

2:41

of them would get you to category four B.

2:44

We don't wanna forget to look at the rest of the lung

2:47

and just be focused on that.

2:48

Looking for other pulmonary nodules, again, we see more of

2:51

that extensive smaller wall thickening

2:55

and flip on our mips, again, helps us find

2:58

Nodules.

2:59

And you can see they just kind of pop out in the background

3:03

relative to the pulmonary vessels,

3:05

almost like little buds on a tree at springtime, after all.

3:09

So a cystic lesion

3:11

with excentric nodularity category four B.

3:14

This patient subsequently underwent a right upper lobectomy,

3:18

and this was an invasive adenocarcinoma

3:21

with some mucinous features we wouldn't be able

3:23

to detect whether it was mucinous.

3:26

We usually look for areas of ground glass

3:27

for mucinous adenocarcinomas, but we don't see that.

3:30

So an invasive adenocarcinoma, right upper lobectomy

3:34

and a complex part cystic part,

3:37

solid multi lobulated nodule on lung cancer screening, CT

3:41

and an asymptomatic individual.