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Let's take a look at this lung cancer screening case

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and a 76-year-old woman who has a 40 pack year history

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of smoking and continues to actively smoke cigarettes.

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She's had multiple serial screening cts previously

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and we'll take a look at those as they may impact

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how we interpret this current exam.

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Starting from the beginning of the chest, as is very common,

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we see mild upper lung predominant central lobular emphysema

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as evidence of cigarette smoking related lung disease.

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And we quickly come into this irregular peripheral nodule in

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the left upper lobe and as we magnify it up a little bit

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to take a better look at its morphology, it has areas

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of ground glass, increased lung density

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through which we can still see normal

0:45

bronchovascular architecture.

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It has solid areas in the middle of the ground glass.

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It has larger areas of solid

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that are a bit separate from the areas of ground glass

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and it even has a small eccentric cystic component.

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It is abutting the pleural surface.

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And if we look carefully,

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if a bronchoscopist pulmonary medicine physician were

1:08

to consider doing some sort of bronchoscopic biopsy,

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we can see a small bronchus running right into it,

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which would be good, helpful sign to the bronchoscopist

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and something they would be looking for

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as the determining if a nodule is

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amenable for them to reach.

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So we have this nodule with solid

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and ground glass components

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that makes this a part solid nodule.

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Part solid nodules have the highest risk of malignancy

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of any specific nodule type.

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So while solid nodules are more common part,

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solid nodules are more likely to be lung cancer.

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We just don't see that many of them.

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And when we're looking at part solid nodules,

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we're gonna go back and look over time

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and see if this nodule was present before

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and if it's changed 'cause

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that can impact our next recommendation.

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Of course, we're gonna continue to look through the exam

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for other significant nodules,

1:58

which on serial lung cancer screening cts are new nodules

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that are six centimeters and greater.

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If they're solid. Those are the most common

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nodules that we find.

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And there may be some small four millimeter

2:09

and smaller nodules that have been there for quite some time

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and unchanged that we'll consider a benign

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and something we'll be able to track

2:17

with the next annual screening ct.

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Well what did that nacho look like before?

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So on the left is the current ct

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and then I have exams going back in time.

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The CT on the left is from

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November, 2023 of a ct.

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Just to the right of that.

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The second CT, he

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where we can still see the nodular abnormality

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is from eight months earlier.

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We have one from an additional six months before that

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and an additional seven months for that.

2:46

So we've been watching this nodule grow

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between November, 2021 on the far right

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and November, 2023 on the left.

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So we have two years of history

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of this nodule and if we look at it

2:58

On the first ct,

3:00

it has a predominantly ground glass component

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with some small solid areas in it,

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but the solid component is not as dominant as it is now.

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And over time the solid component within the nodule has

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gradually increased and the nodule over overall has

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increased in size.

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Six months before the exam

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that we were currently looking at,

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it made a significant change, developed

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that cystic component.

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The nodular component in the middle was continuing

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to get bigger and the whole nodule was increasing.

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And then when we get to the exam

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that we're currently looking at,

3:33

the nodular component has significantly increased in size,

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has a large um, component that's contiguous

3:39

with the pleural surface and at this time is when the

3:42

referring physicians took action.

3:45

So this makes this a lung where adds four B.

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It's a growing part, solid nodule

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that also has a cystic components.

3:52

This patient subsequently underwent a left upper lobe tris

3:56

segmentectomy, meaning they took out the apical anterior

3:59

posterior segments and left the lingual intact

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and were able to preserve that amount of lung.

4:04

And this patient proved to have an invasive adenocarcinoma

4:08

with mixed elements in it.

4:09

It had an invasive component, which is the solid component

4:13

that you see, but it also had a lipic component, a component

4:17

that just grows along the normal lung architecture, which is

4:20

what the ground glass component represents.

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So we're seeing two different elements

4:24

of this invasive adenocarcinoma,

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the solid invasive component, the growing solid component,

4:30

and the ground glass representing the lipid component.

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So whenever you have a ground glass nodule

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and you're looking at it on serial cts in the future,

4:39

you're always gonna look carefully

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for if there's a solid component within it as well as look

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for overall growth of the nodules.

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So that is a lung RADS four B growing part, solid nodule.