Fast and Effective Diagnosis in Solitary Pulmonary Nodules: Video Assisted Thoracic Surgery

This is the authors' abstract. We don't add key points for this paper.

Objective: Despite the developments in imaging techniques, and mostly the determination of solitary pulmonary nodules being detectable, the optimal management of the solitary pulmonary nodules is still controversial. The aim of this study is to evaluate the effectiveness of the diagnostic tests and determine a fast and effective approach to solitary pulmonary nodules. Material and Methods: Records of the 82 patients with solitary pulmonary nodule who underwent open resection or video-assisted thoracic surgery for certain diagnosis or treatment between December 2001 and June 2011 were examined retrospectively. The patients were evaluated in terms of age, sex, smoking history, existence of extra-thoracal malignancy, imaging techniques, invasive procedures including bronchoscopy and/or thorax computerized tomography guided transthoracic needle biopsy, surgical processes, morbidity, mortality and histopathologic diagnosis. Results: Surgical tissue diagnoses were provided for all patients. Video-assisted thoracic surgery was used to get the tissue diagnoses in 53 patients, and open lung biopsy was used in 26 patients. In 3 cases the tissue diagnoses were obtained by thorax computerized tomography-guided transthoracic needle biopsy. Forty-four of the patients underwent surgical anatomic resection at the same session. Definitive diagnoses consisted of 49 (60%) malignant lesions, and 33 (40%) benign lesions. All patients were evaluated with thorax computerized tomography, 60 of them underwent positron emission tomography and 35 patients had invasive procedures consisting of bronchoscopy and/or thorax computerized tomography-guided transthoracic needle biopsy. The rate of definitive diagnosis by thorax computerized tomography-guided transthoracic needle biopsy was only 14%, while definitive diagnosis could not be obtained by bronchoscopy in any patients. General diagnostic accuracy rates, sensitivity, specifity, negative and positive predictive values between positron emission tomography and thorax computerized tomography were statistically non-significant. Conclusion: After radiological evaluation with thorax computerized tomography, we have considered that an option should be advised to the patients, skipping other diagnostic tests, and administering video assisted thoracic surgery to patients to provide a tissue diagnosis. Also if indicated and in proper cases, administering anatomic resection at the same session might be possible.