American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended procedure for a solitary pulmonary nodule greater than 8 mm with a high pretest probability of malignancy?

1. Surgical excision without imaging

2. Immediate chemotherapy treatment

3. Watchful waiting

4. Surgical excision after considering PET/CT imaging for staging

The correct answer is: Surgical excision after considering PET/CT imaging for staging

For a solitary pulmonary nodule greater than 8 mm that has a high pretest probability of malignancy, the recommended procedure involves surgical excision after considering the use of PET/CT imaging for staging. This approach is appropriate due to several key factors. First, the size of the nodule (greater than 8 mm) combined with a high suspicion for malignancy indicates that there is a significant potential for the presence of lung cancer. Surgical excision is often necessary to obtain a definitive diagnosis through histological evaluation, which is crucial for determining the appropriate treatment. Additionally, incorporating PET/CT imaging into the evaluation process allows for better staging of the nodule. PET scans provide metabolic information that can help differentiate between benign and malignant processes, assess for possible metastases, and inform the surgical decisions regarding the extent of intervention required. The imaging guides the clinician in accurately staging the disease, which is essential for planning subsequent treatment, if cancer is confirmed. This multifaceted approach of utilizing imaging to inform surgical decisions and then proceeding with excision is supported by current guidelines for managing pulmonary nodules with a significant likelihood of malignancy, thus optimizing patient outcomes.