Solitary Pulmonary Nodule — Viva Defence

Opening statement (SASPOP, delivered aloud)

"Mr Doyle is a 67-year-old ex-smoker with an incidental 11 mm spiculated solid nodule in the right upper lobe, on a background of severe emphysema and significant ischaemic heart disease with impaired ventricular function. His main problems are: a radiologically suspicious nodule whose malignancy probability is high enough that surveillance alone is not defensible; severely limited pulmonary reserve that makes both transthoracic biopsy hazardous and any resection marginal; cardiac comorbidity that compounds procedural risk; and acute anxiety about a possible cancer diagnosis. I would like to establish the nodule's temporal behaviour by finding prior imaging, quantify risk formally, characterise it with PET-CT, obtain tissue by the safest route — which in him is bronchoscopic, not percutaneous — and take every fork of this pathway through the lung nodule MDT with his preferences heard at each step." ^{[1] [2]}