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British Thoracic Society Guidelines on Lung nodules #Vama2015
- 1. Tudor Toma, MD PhD, Consultant Respiratory Physician & Honorary Clinical Senior Lecturer, University Hospital Lewisham - Greenwich NHS Trust & King's College London. British Thoracic Society guidelines for the investigation and management of pulmonary nodules Volume 70 Supplement 2 | THORAX August 2015
- 3. Guideline Approach Advantages Everybody works the same You don’t need to be expert Rapid solutions Efficient use of resources Reduce risk of litigation Disadvantages Difficult with complex cases Un-personalised approach Patient not involved
- 4. How to work with a Guideline? Step 1 –Clinical judgement • Start with a rigid approach. • Work like a machine. Do not improvise. • Solution? No? Move to next step. Step 2 – Superior knowledge • Particularities? • Use MDTs • Check specific protocols Step 3 - Expert • Ask experts • Check case presentations • Write & present your case
- 5. So, what is the problem? Please guess if this nodule is malignant or not?
- 6. Solution Do a risk assessment on the basis of: - Nodule’s CT characteristics - Clinical history
- 7. How do we solve the problem?
- 8. Answer the following questions 1. What type/density of nodule do you see? 2. What is the size of the nodule? 3. What is the clinical risk of malignancy? 4. How frequently do you need to re-scan for surveillance? 5. Nodule grows or seems malignant. What to do next? 6. How should you organise your service?
- 9. Question 1 What type/density of nodule do you see?
- 13. Question 2 What is the size of the nodule?
- 14. Initial approach
- 15. Question 3 What is the clinical risk of malignancy?
- 17. Question 4 How frequently do you need to re-scan for surveillance?
- 18. Solid nodule surveillance algorithm
- 20. Question 5 Nodule grows or seems malignant. What to do next?
- 22. Question 6 How should you organise your service?
- 24. Your practice Audit Share Connect & Network
- 25. Conclusions Follow the guidelines! Standardise: Assessment of the risk. Nodules’ monitoring approach. Consider CT guided biopsy vs. surgery. Audit & evaluate your practice. Volume 70 Supplement 2 | THORAX August 2015
Hinweis der Redaktion
- Please give me some Advantages and disadvantages.
- Advantages: everybody works the same, you do not need to be an expert to be able to do the job, rapid solution in most of cases, efficient use of resources. Disadvantages: complex cases may be initially mismanaged.
- Advantages: everybody works the same, you do not need to be an expert to be able to do the job, rapid solution in most of cases, efficient use of resources. Disadvantages: complex cases may be initially mismanaged. Start rigid and loosen up latter. Work first like a machine and then like an artist. These recommendations may not be appropriate for use in all situations. Use clinical judgement, knowledge and expertise. Start rigid and loosen up latter.
- We now know that from 20 nodules 1 is malignant.
- Typical benign features – hamartoma or perifisural nodes.