CT scanning also allows for the radiographic examination of the mediastinum, liver, and adrenal glands to stage the patient for possible future surgical procedures. Malignant nodules take up more tracer than normal tissue or granulomas. This expensive new scan awaits the results of ongoing multicenter evaluations but may offer the ability to characterize the primary nodule and screen for regional and distant metastases. The primary goal in attempting to biopsy a SPN is to establish a benign diagnosis and spare the patient an invasive surgical procedure. However, in some instances a diagnosis of malignancy up front can be useful.
Many patients are hesitant to undergo thoracic surgery without knowing they have a cancer.
In other patients at moderate to high risk for surgical exploration, a positive preoperative biopsy may put to rest fears that a risky procedure may be unnecessary. Finally, in the setting of a known extrathoracic malignancy, determining that the SPN represents a distant metastasis versus a new primary lung cancer may alter therapeutic plans. The yield for benign lesions may be even lower. Thus, a nondiagnostic FOB biopsy should not alter plans to proceed with resection. The yield for benign nodule varies with the size of the needle used and the experience of the pathologist interpreting the study.