SOLITARY LUNG LESIONS: CURRENT PROBLEMS OF DIAGNOSIS AND TREATMENT

Solitary lung lesions are among the most frequently detected clinico-radiological problems in modern med­icine, largely due to the widespread use of chest computed tomography (CT) and lung cancer screening. Although the majority of solitary pulmonary nodules are benign, some may represent an early manifestation of primary lung cancer. Therefore, the main objective of the diagnostic strategy is to achieve a balance between two opposing risks: on the one hand, to avoid unnecessary investigations, invasive biopsy, and unwarranted surgical interventions for benign lesions; and on the other hand, to prevent underestimation of malignant lesions, failure to adhere to recom­mended follow-up, and delays in the diagnosis of lung cancer.

This article is devoted to an analysis of the major challenges in the diagnosis and treatment of solitary lung lesions based on contemporary scientific literature, expert consensus statements, and clinical recommendations pub­lished between 2022 and 2026. Currently, CT remains the primary method for detecting solitary pulmonary nodules, their initial assessment, and longitudinal follow-up. Nodule size, density, margin characteristics, location, calcification, and growth dynamics, as well as the patient's age, smoking history, and oncological history, are important factors in assessing the risk of malignancy. PET/CT and morphological examination can help refine the diagnostic algorithm in patients with high or intermediate risk. However, invasive procedures may be associated with pneumothorax, bleed­ing, and other complications. At the same time, loss to follow-up or failure to reassess CT findings in a timely manner may result in delayed detection of lung cancer and disease progression.

Thus, the optimal strategy for managing patients with solitary lung lesions is not to pursue “more testing,” but rather to accurately assess the level of risk, implement standardized follow-up, perform minimally invasive mor­phological evaluation when indicated, and apply a multidisciplinary approach.