Chest
Volume 116, Supplement 3, December 1999, Pages 523S-524S
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Management of the Solitary Pulmonary Nodule: Role of Thoracoscopy in Diagnosis and Therapy

https://doi.org/10.1378/chest.116.suppl_3.523SGet rights and content

Objectives

The solitary pulmonary nodule remains acommon clinical problem. The essential question is whether the lesionis malignant or not. This discussion presents the clinical practice andlooks at the problem.

Design

Didactic.

Setting

Academic tertiary-care hospital.

Patients

Prospective thoracic database.

Interventions

Minimally invasivetechnique.

Results

The workup and treatment ofthe solitary pulmonary nodule is presented with particular emphasis onthe role of minimally invasive techniques. A small single-institutionseries is referenced.

Conclusions

The approach issafe and highly effective in diagnosing and often in treating solitarypulmonary nodules.

Section snippets

Diagnosis

The presumed diagnosis of the solitary pulmonary nodule is based on several factors. The age of the patient, associated symptoms, risk factors, and appearance of the lesion on the radiograph, including the length of time lesion has been present, all give the clinician information on which to base a working diagnosis. Obviously, it is important to obtain a precise history that includes travel experience, details of nicotine and asbestos exposure, any symptoms related to the respiratory tract (eg

Thoracoscopic Diagnosis and Treatment

Clearly, if a patient is a candidate for surgery, then surgery is the procedure of choice to make a definitive diagnosis and, in many instances, to provide therapy. Most diagnoses are very difficult to establish without excision of the lesion. Fungal infection and hamartomas on occasion can be diagnosed without removing the entire lesion. However, much caution must be exercised in accepting a benign diagnosis of a solitary pulmonary nodule on the basis of partial information.

Minimally invasive

Conclusion

The appearance of a solitary pulmonary nodule remains a common clinical problem. The essential question is whether the lesion is malignant. If the patient is a reasonable surgical candidate, surgical excision, in particular thoracoscopic resection, is the best strategy available for establishing a diagnosis. The sensitivity and specificity of this technique approaches 100%. Additionally, definitive therapy may be accomplished during the same operative procedure. Newer diagnostic techniques,

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