Chávez-Tapia NC, Pichardo-Bahena R, Méndez-Sánchez N

Language: Spanish
References: 15
Page: 64-72
PDF size: 547.28 Kb.

ABSTRACT

This article provided an evidence based review about the solitary pulmonary nodule. The English available medical literature was reviewed and level of evidence was II or IIA. The solitary pulmonary nodule is common clinical situation, being in 1 of each 500 X-rays of thorax. The importance of a precise diagnosis is based on its possible malignancy, and the morbidity associated to its diagnosis by invasive methods. The operational definition of solitary pulmonary nodule is unique image, smaller than 3 centimeters, not associated to atelectasis or adenopathy. The nodule can be defined as benign, malignant, or not determined. The etiology its diverse on the basis of the center where it is made the diagnosis, the diagnostic method, and the location of the nodule. Clinical, radiological and computed tomography patterns help us to determine the diagnosis. Within the noninvasive methods of diagnosis they are the computed tomography, in special the spiral computed tomography with fine cuts. The gold standard within the noninvasive methods is the tomography by positron emission, actually few medical center has it. A similar method similar about sensitivity as specificity is single photon emission computed tomography marked with 99mTc-P829. The invasive methods that are associated to a variable morbidity like computed tomography guided fine needle aspiration, bronchoscopy, the thoracoscopy guided by video and finally thoracotomy, show higher diagnostic rates. Prediction models exist that can orient the diagnosis of benignancy or malignancy, the model that applies to the theorem of Bayes and the multivaried model, the multivariate model has been validated and evaluated against clinical observers having adequate levels of trustworthiness. The diagnosis of the pulmonary nodule requires a suitable clinical evaluation and the judicious application of diagnosis methods that based on the medicine evidence based will improve the quality of the medical attention.

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