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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
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?
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
Notas del editor
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.
