{{Infobox medical condition (new) | name = Lung nodule | synonyms = | image = Thorax pa peripheres Bronchialcarcinom li OF markiert.jpg | caption = [[Chest X-ray]] showing a '''solitary pulmonary nodule''' (indicated by a black box) in the left upper lobe. | pronounce = | field = | | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} A '''lung nodule''' or '''pulmonary nodule''' is a relatively small focal density in the [[lung]]. A '''solitary pulmonary nodule''' ('''SPN''') or '''coin lesion''',<ref>{{Cite web|url=https://radiopaedia.org/articles/coin-lesion-lung?lang=gb|title=Coin lesion (lung) &#124; Radiology Reference Article &#124; Radiopaedia.org|first=Henry|last=Knipe|website=Radiopaedia}}</ref> is a [[tumor|mass]] in the [[lung]] smaller than three centimeters in diameter. A '''pulmonary micronodule''' has a diameter of less than three millimetres.<ref name="RSNA">{{cite journal |last1=de Margerie-Mellon |first1=Constance |last2=Bankier |first2=Alexander A. |title=To Be or Not to Be … a Pulmonary Nodule |journal=Radiology: Cardiothoracic Imaging |article-number=e190201 |doi=10.1148/ryct.2019190201 |date=1 December 2019|volume=1 |issue=5 |pmid=33778533 |pmc=7977753 }}</ref> There may also be multiple nodules.

One or more lung nodules can be an [[incidentaloma|incidental finding]] found in up to 0.2% of [[chest X-ray]]s<ref name="NEJM-cp">{{cite journal | vauthors = Ost D, Fein AM, Feinsilver SH | title = Clinical practice. The solitary pulmonary nodule | journal = The New England Journal of Medicine | volume = 348 | issue = 25 | pages = 2535–2542 | date = June 2003 | pmid = 12815140 | doi = 10.1056/NEJMcp012290 }}</ref> and around 1% of [[CT scan]]s.<ref name="pmid18402653">{{cite journal | vauthors = Alzahouri K, Velten M, Arveux P, Woronoff-Lemsi MC, Jolly D, Guillemin F | title = Management of SPN in France. Pathways for definitive diagnosis of solitary pulmonary nodule: a multicentre study in 18 French districts | journal = BMC Cancer | volume = 8 | page = 93 | date = April 2008 | pmid = 18402653 | pmc = 2373300 | doi = 10.1186/1471-2407-8-93 | doi-access = free }}</ref>

The [[Nodule (medicine)|nodule]] most commonly represents a [[benign]] tumor such as a [[granuloma]] or [[hamartoma]], but in around 20% of cases it represents a [[malignant]] [[cancer]],<ref name="pmid18402653"/> especially in [[elderly|older adults]] and [[tobacco smoking|smokers]]. Conversely, 10 to 20% of patients with [[lung cancer]] are diagnosed in this way.<ref name="pmid18402653"/> If the patient has a history of smoking or the nodule is growing, the possibility of cancer may need to be excluded through further radiological studies and interventions, possibly including [[Surgery#Types|surgical resection]]. The [[prognosis]] depends on the underlying condition.

==Causes== Not every round spot on a radiological image is a solitary pulmonary nodule: it may be confused with the projection of a structure of the [[chest wall]] or skin, such as a [[nipple]], a healing [[rib fracture]] or [[electrocardiography|electrocardiographic]] monitoring.

The most important cause to exclude is any form of [[lung cancer]],<ref>{{cite journal | vauthors = Thiessen NR, Bremner R | title = The solitary pulmonary nodule: approach for a general surgeon | journal = The Surgical Clinics of North America | volume = 90 | issue = 5 | pages = 1003–1018 | date = October 2010 | pmid = 20955880 | doi = 10.1016/j.suc.2010.07.002 }}</ref> including rare forms such as primary pulmonary [[lymphoma]], [[carcinoid tumor]] and a solitary [[metastasis]] to the lung (common unrecognised primary tumor sites are [[melanoma]]s, [[sarcoma]]s or [[testicular cancer]]). Benign tumors in the lung include [[hamartoma]]s and [[chondroma]]s.

The most common benign coin lesion is a [[granuloma]] (inflammatory [[Nodule (medicine)|nodule]]), for example due to [[tuberculosis]] or a [[Mycosis|fungal infection]], such as [[Coccidioidomycosis]].<ref name=Jude2014>{{cite journal | vauthors = Jude CM, Nayak NB, Patel MK, Deshmukh M, Batra P | title = Pulmonary coccidioidomycosis: pictorial review of chest radiographic and CT findings | journal = Radiographics | volume = 34 | issue = 4 | pages = 912–925 | date = 2014 | pmid = 25019431 | doi = 10.1148/rg.344130134 }}</ref> Other infectious causes include a [[lung abscess]], [[pneumonia]] (including [[pneumocystis pneumonia]]) or rarely [[nocardia]]l infection or worm infection (such as [[dirofilariasis]] or [[Dirofilaria immitis|dog heartworm]] infestation). Lung nodules can also occur in [[immune disorder]]s, such as [[rheumatoid arthritis]] or [[granulomatosis with polyangiitis]], or [[organizing pneumonia]].

A solitary lung nodule can be found to be an [[arteriovenous malformation]], a [[hematoma]] or an [[infarction]] zone. It may also be caused by [[Bronchus#Bronchial atresia|bronchial atresia]], [[Pulmonary sequestration|sequestration]], an inhaled [[foreign body]] or [[pleural plaque]].

==Risk factors== Risk factors for incidentally discovered nodules are mainly: * [[Lung cancer#Causes|'''General risk factors''' of lung cancer]] such as exposure to [[tobacco smoking]] or other [[carcinogen]]s such as [[asbestos]] and previously diagnosed cancer, [[respiratory infection]]s, or [[chronic obstructive pulmonary disease]].<ref name=Zhan2013>{{cite journal | vauthors = Zhan P, Xie H, Xu C, Hao K, Hou Z, Song Y | title = Management strategy of solitary pulmonary nodules | journal = Journal of Thoracic Disease | volume = 5 | issue = 6 | pages = 824–829 | date = December 2013 | pmid = 24409361 | pmc = 3886686 | doi = 10.3978/j.issn.2072-1439.2013.12.13 }}</ref> * '''Size''': larger size confers a higher risk of cancer<ref name="MacMahonNaidich2017">{{cite journal | vauthors = MacMahon H, Naidich DP, Goo JM, Lee KS, Leung AN, Mayo JR, Mehta AC, Ohno Y, Powell CA, Prokop M, Rubin GD, Schaefer-Prokop CM, Travis WD, Van Schil PE, Bankier AA | display-authors = 6 | title = Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017 | journal = Radiology | volume = 284 | issue = 1 | pages = 228–243 | date = July 2017 | pmid = 28240562 | doi = 10.1148/radiol.2017161659 | doi-access = }}</ref>

* '''Location''': Upper lobe location is a risk factor for cancer, while a location close to a [[lung fissure|fissure]] or the [[pleura]] indicates a benign lymph node,<ref name="MacMahonNaidich2017"/> especially if having a triangular shape.<ref name=Snoeckx2017>{{cite journal | vauthors = Snoeckx A, Reyntiens P, Desbuquoit D, Spinhoven MJ, Van Schil PE, van Meerbeeck JP, Parizel PM | title = Evaluation of the solitary pulmonary nodule: size matters, but do not ignore the power of morphology | journal = Insights into Imaging | volume = 9 | issue = 1 | pages = 73–86 | date = February 2018 | pmid = 29143191 | pmc = 5825309 | doi = 10.1007/s13244-017-0581-2 }}</ref> * '''Margin''' morphology: a spiculated margin is a risk factor for cancer.<ref name="MacMahonNaidich2017"/> Benign causes tend to have a well defined border, whereas lobulated lesions or those with an irregular margin extending into the neighbouring tissue tend to be malignant.<ref name="Radiology2006"/> In particular, spiculations are highly predictive of malignancy with a positive predictive value up to 90%.<ref name=Snoeckx2017/> Also, a "notch sign", which is an abrupt indentation of the nodule, increases the risk of cancer, but may also be found in granulomatous diseases.<ref name=Snoeckx2017/> <gallery mode=packed heights=190> File:CT of a subpleural nodule.png|subpleural nodule.<ref name=Snoeckx2017/> File:CT of a round well-delineated solid lung nodule with smooth border.jpg|Round well-delineated solid lung nodule with smooth border.<ref name=Snoeckx2017/> File:CT of a lobulated lung nodule.png|Lobulated nodule.<ref name=Snoeckx2017/> File:CT of a spiculated lung nodule.png|Spiculated lung nodule.<ref name=Snoeckx2017/> File:CT of a lung nodule with a notch sign.png|A "notch sign".<ref name=Snoeckx2017/> File:CT of perifissural nodule.png|A triangular perifissural node can be diagnosed as a benign lymph node.<ref name=Snoeckx2017/> </gallery> * '''Multiplicity''': Where the presence of up to an additional 3 nodules has been found to increase the risk of cancer, but decrease in case of 4 or more additional ones, likely because it indicates a previous granulomatous infection rather than cancer.<ref name="MacMahonNaidich2017"/> * '''Growth''' rate: solid cancers generally doubles in volume over between 100 and 400 days, while subsolid cancers (generally representing adenocarcinomas) generally doubles in volume over 3 to 5 years.<ref name="MacMahonNaidich2017"/> One volume doubling equals approximately a 26% increase in diameter.<ref name="MacMahonNaidich2017"/> * Presence of '''[[Chronic obstructive pulmonary disease#Pathophysiology|emphysema]]''' and/or '''[[lung fibrosis|fibrosis]]''' is a risk factor for cancer.<ref name="MacMahonNaidich2017"/> In comparison, the typical size doubling are less than 20 days for infections, and more than 400 days for benign nodules.<ref>{{cite journal | vauthors = Truong MT, Ko JP, Rossi SE, Rossi I, Viswanathan C, Bruzzi JF, Marom EM, Erasmus JJ | display-authors = 6 | title = Update in the evaluation of the solitary pulmonary nodule | journal = Radiographics | volume = 34 | issue = 6 | pages = 1658–1679 | date = October 2014 | pmid = 25310422 | doi = 10.1148/rg.346130092 | doi-access = }}</ref> * '''Enhancement''': If the exam is done as a combined non-contrast and [[contrast CT]], a solitary nodule with an enhancement off less than 15 [[Hounsfield unit]]s (HU), whereas a higher enhancement indicates a malignant tumor (with a [[sensitivity and specificity|sensitivity]] estimated at 98%).<ref name=Medscape>{{cite journal|url=https://emedicine.medscape.com/article/358090-overview#a3|title=Lung Metastases Imaging|author=Tanay Patel|website=[[Medscape]]|date=2019-02-25}} Updated: Sep 30, 2018</ref> * Areas of '''fatty tissue''' (−40 to −120 HU) indicates a [[hamartoma]]. However, only about 50% of hamartomas are fat containing.<ref name=Snoeckx2017/> * If there is a '''central cavity''', then a thin wall points to a benign cause whereas a thick wall is associated with malignancy (especially 4&nbsp;mm or less versus 16&nbsp;mm or more).<ref name="Radiology2006"/> <gallery> File:CT of a fat containing hamartoma.png|Low attenuating nodule (in this case a fat containing hamartoma).<ref name=Snoeckx2017/> File:CT of an aspergilloma.png|Cavitation with relatively thick wall, in this case [[aspergilloma]]).<ref name=Snoeckx2017/> </gallery> [[File:CT of a hamartoma.png|thumb|Calcifications and popcorn-like appearance, conferring a diagnosis of hamartoma.<ref name=Snoeckx2017/>]] * In case of '''calcifications''', a popcorn-like appearance indicates a hamartoma, which is benign.<ref name="NEJM-cp"/> * In case of '''subsolid''' nodules, being part solid has a higher risk of cancer than being purely [[ground glass opacity]]. <gallery mode=packed heights=190> File:CT of part solid lung nodule.png|Part solid nodule.<ref name=Snoeckx2017/> File:CT of ground glass lung nodule.png|[[Ground glass opacity]] nodule.<ref name=Snoeckx2017/> </gallery> * '''Pleural retraction''' is far more common in cancers.<ref name=Snoeckx2017/> It is the pulling of visceral pleura towards the nodule.<ref name=Snoeckx2017/> <gallery mode=packed heights=190> File:CT of a lung nodule with pleural retraction.png|Nodule with pleural retraction.<ref name=Snoeckx2017/> File:CT of a subpleural nodule with pleural retraction.png|In this case, pleural retraction is seen as a triangular fat component.<ref name=Snoeckx2017/> </gallery> [[File:CT of a lung nodule abutting a cystic airspace.png|thumb|180px|Lung nodule abutting a pulmonary cyst.<ref name=Snoeckx2017/>]] * A lung nodule '''abutting a [[pulmonary cyst]]''' is a rare finding, yet indicating cancer.<ref name=Snoeckx2017/> * '''Bubble-like lucencies''' in the nodule indicate cancer:<ref name=Snoeckx2017/> <gallery mode=packed heights=190> File:CT of spiculated lung nodule with bubble-like lucencies.png File:CT of lung nodule with bubble-like lucencies.png </gallery> [[File:CT of lung nodule with vascular convergence (crop).png|thumb|Thin slice and [[maximal intensity projection]] of a lung nodule, the latter better visualizing vascular convergence.<ref name=Snoeckx2017/>]] * '''Vascular convergence''' is where vessels converge to a nodule without adjoining or contacting the edge of the nodule, and is mainly seen in peripheral subsolid lung cancers.<ref name=Snoeckx2017/> It reflects [[angiogenesis]].<ref name=Snoeckx2017/>

[[Air bronchogram]]s is defined as a pattern of air-filled bronchi on a background of airless lung, and may be seen in both benign and malignant nodules, but certain patterns thereof may help in risk stratification.<ref name=Snoeckx2017/> {{Further|Air bronchogram}}

CT densitometry, measuring absolute attenuation on the [[Hounsfield scale]], has low sensitivity and specificity and is not routinely employed, apart from helping to distinguish solid from ground glass lesions, and to confirm visible fatty areas or calcifications.<ref name=Medscape/>

==Diagnosis== A [[Medical diagnosis#Other diagnostic procedure methods|diagnostic workup]] can include a variety of scans, blood tests, and biopsies.

===Definition=== Nodular density is used to distinguish larger lung tumors, smaller infiltrates or masses with other accompanying characteristics. An often used formal radiological definition is the following: a single lesion in the lung completely surrounded by [[Parenchyma#In animals|functional lung tissue]] with a diameter less than 3&nbsp;cm and without associated [[pneumonia]], [[atelectasis]] (lung collapse) or [[lymphadenopathy|lymphadenopathies]] (swollen lymph nodes).<ref name="pmid12527568">{{cite journal | vauthors = Tan BB, Flaherty KR, Kazerooni EA, Iannettoni MD | title = The solitary pulmonary nodule | journal = Chest | volume = 123 | issue = 1 Suppl | pages = 89S–96S | date = January 2003 | pmid = 12527568 | doi = 10.1378/chest.123.1_suppl.89S | url = http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=12527568 | author5 = American College of Chest Physicians | archive-url = https://archive.today/20130112232936/http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=12527568 | archive-date = 2013-01-12 }}</ref><ref name="Radiology2006">{{cite journal | vauthors = Winer-Muram HT | title = The solitary pulmonary nodule | journal = Radiology | volume = 239 | issue = 1 | pages = 34–49 | date = April 2006 | pmid = 16567482 | doi = 10.1148/radiol.2391050343 }}</ref>

===CT scan=== For incidentally detected nodules on CT scan, [[Fleischner Society]] guidelines are given in table below. For multiple nodes, management is based on the most suspicious node.<ref name="MacMahonNaidich2017"/> These guidelines do not apply in lung cancer screening, in patients with immunosuppression, or in patients with known primary cancer.<ref name="MacMahonNaidich2017"/>

{|class="wikitable" |+Solid nodules<ref name="MacMahonNaidich2017"/> |- !colspan=2| !! <6&nbsp;mm (<100mm<sup>3</sup>) !! 6–8mm (100–250mm<sup>3</sup>) !! >8mm (>250mm<sup>3</sup>) |- !rowspan=2| Single<br /> nodule !! Low risk | No routine follow-up || CT after 6–12 months, then consider CT after 18–24 months ||rowspan=2| Consider CT at 3 months, [[PET-CT]] or biopsy |- ! High risk | Optionally, CT after 12 months || CT after 6–12 months, then after 18–24 months |- !rowspan=2| Multiple<br /> nodules !! Low risk | No routine follow-up ||colspan=2 align=center| CT after 3–6 months, then consider CT after 18–24 months |- ! High risk | Optionally CT after 12 months ||colspan=2 align=center| CT after 3–6 months, then after 18–24 months |}

{|class="wikitable" |+Subsolid nodules<ref name="MacMahonNaidich2017"/> |- !colspan=2| !! Total size <6&nbsp;mm (<100mm<sup>3</sup>) !! Total size >6mm (>100<sup>3</sup>) |- !rowspan=2| Single<br /> nodule !! [[Ground glass opacity]] | No routine follow-up || CT after 6–12 months to check if persistent, then after 2 years and then another 2 years |- ! Part solid | No routine follow-up || CT after 6–12 months: * If unchanged and solid component remains <6mm: Annual CT for 5 years. * Solid component ≥6mm: highly suspicious | |- !colspan=2| Multiple<br /> nodules | CT after 3–6 months. If stable, consider CT after 2 and then another 2 years. || CT after 3–6 months, then after 18–24 months |}

More frequent CT scans than what is recommended has not been shown to improve outcomes but will increase radiation exposure and the [[unnecessary health care]] can be expected to make the patient anxious and uncertain.<ref name="ACCPandATSfive-1b">{{Cite journal|author1 = American College of Chest Physicians |author1-link = American College of Chest Physicians |author2 = American Thoracic Society |author2-link = American Thoracic Society |date = September 2013 |title = Five Things Physicians and Patients Should Question |publisher = American College of Chest Physicians and American Thoracic Society |journal = Choosing Wisely: An Initiative of the ABIM Foundation |url = http://www.choosingwisely.org/doctor-patient-lists/american-college-of-chest-physicians-and-american-thoracic-society/ |access-date = 6 January 2013}}, which cites * {{cite journal | vauthors = Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R, Berrington de González A, Miglioretti DL | display-authors = 6 | title = Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer | journal = Archives of Internal Medicine | volume = 169 | issue = 22 | pages = 2078–2086 | date = December 2009 | pmid = 20008690 | pmc = 4635397 | doi = 10.1001/archinternmed.2009.427 | author8-link = Diana Miglioretti }} * {{cite journal | vauthors = Wiener RS, Gould MK, Woloshin S, Schwartz LM, Clark JA | title = What do you mean, a spot?: A qualitative analysis of patients' reactions to discussions with their physicians about pulmonary nodules | journal = Chest | volume = 143 | issue = 3 | pages = 672–677 | date = March 2013 | pmid = 22814873 | pmc = 3590883 | doi = 10.1378/chest.12-1095 }}</ref>

===PET scan=== [[Image:FDG-PET initial study solitary pulmonary nodule Non-Hodgkin lymphoma.jpg|thumb|[[FDG-PET]] study of a 71-year-old woman with a solitary pulmonary nodule (''thin arrow'') in the left lower lobe near the heart. The scan also revealed abnormal increased activity at the [[gastro-esophageal junction]] (''thick arrow''). The final diagnosis was [[non-Hodgkin lymphoma]] at both sites.]] If there is an intermediate risk of malignancy, further imaging with [[positron emission tomography]] (PET scan) is appropriate (if available). It can be done simultaneously as a CT scan in the form of [[PET-CT]]. Around 95% of patients with a malignant nodule will have an abnormal PET scan, while around 78% of patients with a benign nodule will look normal on PET (this is the test [[sensitivity and specificity]]).<ref name="JAMA-2001">{{cite journal | vauthors = Gould MK, Maclean CC, Kuschner WG, Rydzak CE, Owens DK | title = Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis | journal = JAMA | volume = 285 | issue = 7 | pages = 914–924 | date = February 2001 | pmid = 11180735 | doi = 10.1001/jama.285.7.914 }}</ref> Thus, an abnormal PET scan will reliably pick up cancer, but several other types of nodules (inflammatory or infectious, for example) will also show up on a PET scan. If the nodule has a diameter of less than one centimeter, PET scans are often avoided because of an increased risk of [[false-negative|falsely normal]] results.<ref name="JAMA-2001"/><ref name="pmid17412254">{{cite journal | vauthors = Khan A | title = ACR Appropriateness Criteria on solitary pulmonary nodule | journal = Journal of the American College of Radiology | volume = 4 | issue = 3 | pages = 152–155 | date = March 2007 | pmid = 17412254 | doi = 10.1016/j.jacr.2006.12.003 }}</ref><ref name="pmid17409830">{{cite journal | vauthors = Vansteenkiste JF, Stroobants SS | title = PET scan in lung cancer: current recommendations and innovation | journal = Journal of Thoracic Oncology | volume = 1 | issue = 1 | pages = 71–73 | date = January 2006 | pmid = 17409830 | doi = 10.1097/01243894-200601000-00014 }}</ref> Cancerous lesions usually have a high [[metabolism]] on PET, as demonstrated by their high uptake of [[fluorodeoxyglucose|FDG]] (a radioactive sugar). <gallery> File:PET-CT of a tuberculoma.png|PET-CT of a [[tuberculoma]]. </gallery>

===Other imaging=== Other potential forms of [[medical imaging]] of pulmonary nodules include [[magnetic resonance imaging]] (MRI) or [[single photon emission computed tomography]] (SPECT).<ref name="pmid18235105">{{cite journal | vauthors = Cronin P, Dwamena BA, Kelly AM, Carlos RC | title = Solitary pulmonary nodules: meta-analytic comparison of cross-sectional imaging modalities for diagnosis of malignancy | journal = Radiology | volume = 246 | issue = 3 | pages = 772–782 | date = March 2008 | pmid = 18235105 | doi = 10.1148/radiol.2463062148 }}</ref>

===Histopathology===

For cases suspicious enough to proceed to [[biopsy]], small biopsies can be obtained by [[fine needle aspiration]] or [[bronchoscopy]] are commonly used for diagnosis of lung nodules.<ref>{{cite journal | vauthors = Mukhopadhyay S | title = Utility of small biopsies for diagnosis of lung nodules: doing more with less | journal = Modern Pathology | volume = 25 | issue = Suppl 1 | pages = S43–S57 | date = January 2012 | pmid = 22214970 | doi = 10.1038/modpathol.2011.153 | doi-access = free }}</ref> CT guided [[Lung biopsy|percutaneous transthoracic needle biopsies]] have also proven to be very helpful in the diagnosis of SPN.<ref name=Jude2014 />

In selected cases, nodules can also be sampled through the airways using [[bronchoscopy]] or through the chest wall using [[fine-needle aspiration]] (which can be done under CT guidance). Needle aspiration can only retrieve groups of cells for [[cytopathology|cytology]] and not a tissue cylinder or biopsy, precluding evaluation of the tissue architecture. Theoretically, this makes the diagnosis of benign conditions more difficult, although rates higher than 90% have been reported.<ref name="pmid8628859">{{cite journal | vauthors = Klein JS, Salomon G, Stewart EA | title = Transthoracic needle biopsy with a coaxially placed 20-gauge automated cutting needle: results in 122 patients | journal = Radiology | volume = 198 | issue = 3 | pages = 715–720 | date = March 1996 | pmid = 8628859 | doi = 10.1148/radiology.198.3.8628859 }}</ref> Complications of the latter technique include hemorrhage into the lung and air leak in the pleural space between the lung and the chest wall ([[pneumothorax]]). However, not all these cases of pneumothorax need treatment with a [[chest tube]].<ref name="pmid10682771">{{cite journal | vauthors = Erasmus JJ, McAdams HP, Connolly JE | title = Solitary pulmonary nodules: Part II. Evaluation of the indeterminate nodule | journal = Radiographics | volume = 20 | issue = 1 | pages = 59–66 | year = 2000 | pmid = 10682771 | doi = 10.1148/radiographics.20.1.g00ja0259 }}</ref>

==Management== ===Excision=== Where workup indicates a high risk of cancer, excision can be performed by [[thoracotomy]] or [[video-assisted thoracoscopic surgery]], which can also confirm the diagnosis by [[histopathology|microscopical examination]].

==See also== * [[Minimally invasive adenocarcinoma of the lung]]

==Footnotes== {{Reflist}}

== External links == {{Medical resources | DiseasesDB = 29456 | ICD10 = {{ICD10|J98.4}}, {{ICD10|R|91}} | ICD9 = {{ICD9|793.11}} | ICDO = | OMIM = | MedlinePlus = 000071 | eMedicineSubj = RADIO | eMedicineTopic = 782 | MeshID = D003074 }} {{Respiratory pathology}} {{Respiratory tract neoplasia}}

[[Category:Lung cancer]]