Lung Nodule Clinic
Thomas Jefferson University's pulmonary division, together with support from related disciplines including radiology, thoracic surgery, and medical/radiation oncology, is leading a novel effort to streamline the initial intake and management of patients with solitary pulmonary lung nodules. This is being spearheaded by the establishment of a pulmonary nodule clinic at Walnut towers ambulatory clinic. This effort is one of the first in the Delaware Valley. The service being provided to any referring physician or patient is the one-stop access to any incidentally-detected pulmonary nodule on any imaging study (plain chest x-ray, CT chest or abdomen, etc). The clinic will be staffed and organized by a nurse coordinator and by pulmonary physicians with expertise to further evaluate such nodules. The management options for a nodule include observation with serial scans (to document stability), a biopsy by either bronchoscopy or percutaneous needle under CT, or surgical resection. Importantly, the clinic will provide the mechanism for seamless follow-up of patients requiring follow-up studies.
A premium will be placed on timely access and evaluation for patients, coordinated communication for referring physicians, and the involvement of any other services required in the Jefferson health system.
In order to access the expertise of the pulmonary nodule clinic, contact:
Nurse practitioner line: (215) 955-2584
Michael Unger, MD & Boyd Hehn, MD
(215) 955-5161 (6591)
Division of Pulmonary & Critical Care Medicine
Thomas Jefferson University/Hospital 834 Walnut St, Suite 650
Philadelphia, PA 19107
Solitary pulmonary nodule or a "spot on the lung" is a very common entity that raises concern amongst clinicians and fear in the lay public. There are many causes for pulmonary nodules, but a third of these maybe lung cancers. Interestingly, no specific medical specialty has provided leadership or a specific program to manage solitary pulmonary nodules. So there is a need for such a service here in Philadelphia and at TJU/H.
It is widely known that lung cancer is a dreaded disease and is causally linked to cigarette smoking, ever since the surgeon general's report in the 1960s. Lung cancer is the most frequent cause of cancer death worldwide and this may be due to the fact that at the usual time of diagnosis the disease is advanced.
A solitary pulmonary nodule (SPN) or coin lesion is a mass in the lung smaller than 3 centimeters in diameter. It can be an incidental finding found on a chest X-ray or CT scan. The nodule may represent a benign process such as a granuloma or hamartoma, but in around 20-40% of cases it represents a malignant cancer, especially in older adults and smokers. Conversely, 10 to 20% of patients with lung cancer are diagnosed in this way. Thus, the possibility of cancer needs to be excluded through further radiological studies and interventions, possibly including surgical resection. The prognosis depends on the underlying condition.
Technology is advancing and the notion of early detection and "screening" for lung cancer has historically been challenging and controversial. However, recent studies and use of "low dose chest CT scan" appears to suggest that screening can improve survival from early detection of lung cancer, by as much as 20%. In addition, other emerging technologies including biomarkers, non-surgical approaches to biopsy, and novel therapies involving radiotherapy is giving hope to patients.