0:00

Hard solid nodules are said

0:02

to be the most challenging lung nodules when reading lung

0:05

cancer screening cts.

0:07

This combination of solid

0:09

and ground glass components can be difficult to measure

0:12

to find the edge of one part

0:13

and the transition zone to the other component.

0:16

It's also very important when we have pure ground glass

0:19

or nonsolid nodules that we look for new, small,

0:22

solid components within them

0:24

as they can represent a new invasive component transitioning

0:28

from a relatively benign acting adenocarcinoma to one

0:32

that is demonstrating invasiveness.

0:35

Part. Solid nodules have the highest risk of lung cancer

0:38

of any nodule type higher than ground glass nodules,

0:41

which may be cancer, but often of an indolent type

0:45

and higher than solid nodules, which may be caused

0:47

with many things such as prior infection

0:49

or being benign in pulmonary lymph nodes.

0:52

This risk of malignancy means we have

0:54

to be particularly careful when looking at these nodules

0:57

and of all the nodule types,

0:59

I spend the most time looking at these thoughtfully.

1:03

Let's look at the Lung-RADS classification

1:05

for part solid nodules

1:06

and then there'll be some cases for you to be able

1:08

to look at and the Lung-RADS categorization.

1:12

A part solid nodule that has a mean diameter

1:14

of under six millimeters is

1:17

considered a lung RADS two nodule

1:18

where the patient will return

1:20

to annual screening in 12 months.

1:22

It's very important that patients adhere

1:25

to annual screening recommendations.

1:27

Not every nodule in category two is going to be benign

1:31

for the duration of a patient's life.

1:33

It may grow, but the probability of growth

1:36

and the probability of causing harm to the patient

1:39

before the next screening CT is very low.

1:42

It's important again to reinforce patients should come back

1:46

for their annual lung cancer screening.

1:49

cts, very important if they have a lung RADS two finding

1:52

where there are nodules that are acting in a benign manner

1:57

or are benign in their general appearance, usually by size

2:01

part solid nodules become category three when they become

2:05

six millimeters or greater in size

2:07

and if they have a six millimeter

2:09

or smaller solid component.

2:12

Importantly, a new part, solid nodule

2:15

between the annual screens

2:16

that is less than six millimeters becomes category three

2:20

'cause it's gone from nothing in that area

2:22

to a completely new nodule.

2:24

So category two under six millimeter part solid nodules on

2:28

baseline CT category three six millimeter

2:32

or greater part solid nodules at any time

2:35

and a new less than six millimeter mean diameter part solid

2:39

nodule on subsequent annual screens.

2:42

As nodules get larger

2:44

or the solid component gets larger,

2:46

then they become category four A and four B lesions.

2:50

Category four A is that same size,

2:52

bigger than six millimeters,

2:54

but the solid component is now ranging

2:57

between six and eight millimeters,

2:59

Or it's a new part, solid nodule that may have a growing

3:04

small solid component.

3:06

By the time you get to category four B part,

3:09

solid nodules have a solid component

3:11

of at least eight millimeters on a baseline CT

3:13

or a newer growing component

3:15

that's greater equal to four millimeters.

3:18

As always, if there are additional features,

3:20

you can upcode the examination

3:21

and totality to a long RAD four X case.

3:25

With that time to take a look at some cases.