A patient presents with a solitary pulmonary nodule (SPN) on x-ray. The best investigation to come to a diagnosis would be :

D i.e. Image guided biopsy Friends don't get surprised! I have checked it from various textbooks. These are the lines from David Sutton ? - Some 40% of solitary pulmonary nodules are malignant with other common lesions being granulomas & benign tumors. - CT scan is most sensitive imaging modality available for identification of pulmonary nodules of . 3mm diameter but relatively insensitive to smaller nodules. The specificity for small nodules is also poor. - Spiral scanning has improved detection rate for pulmonary nodule but has not improved specificity. - The presence of calcification indicates benign lesion but 14% of carcinomas (malignant) show calcification. - The cavitation not necessarily indicates malignant lesion. So summary is, CT scan is most sensitive for detecting large pulmonary nodules ( 3mm) but neither sensitive nor specific for smaller nodules the maximum CT scan can show is calcification & cavitation, which are not always diagnostic of benign & malignant lesions respectively. So the best investigation to come to a diagnosis (i.e. most specific) will be Image guided biopsy.