Diagnostic studies of solitary pulmonary nodule

• PET: detects metab. activity of tumors, 97% Se & 78% Sp for malig (esp if >8 mm). Useful for deciding which lesions to bx vs. serial CT & for surgical staging b/c may detect mets.
• Transthoracic needle biopsy (TTNB): if tech feasible, 97% will obtain definitive tissue dx
• Video-assisted thoracoscopic surgery (VATS): for percutaneously inaccessible lesions; highly sensitive and allows resection
• Transbronchial bx (TBB): most lesions too small to sample w/o endobronchial U/S; bronch w/ brushings low-yield unless invading bronchus; navigational bronch 70% yield
• PPD, fungal serologies, ANCA
• The National Lung Screening Trial, NLST