Chest
Management of the Solitary Pulmonary Nodule: Role of Thoracoscopy in Diagnosis and Therapy
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,
References (12)
- et al.
The cost of diagnosis: a comparison of four different strategies in the workup of solitary radiographic lung lesions
Chest
(1997) - et al.
Integration of transbronchial and percutaneous approach in the diagnosis of peripheral pulmonary nodules or masses: experience with 1,027 consecutive cases
Chest
(1995) - et al.
VATS (video-assisted thoracic surgery) of undefined pulmonary nodules: preoperative evaluation of videoendoscopic resectability
Chest
(1994) - et al.
Needle/wire lung nodule localization for thoracoscopic resection
Chest
(1993) - et al.
CT-guided localizations of pulmonary nodules with methylene blue injections for thoracoscopic resections
Chest
(1994) - et al.
Cost analysis for thoracoscopy: thoracoscopic wedge resection
Ann Thorac Surg
(1993)
Cited by (35)
Anatomic segmentectomy for the solitary pulmonary nodule and early-stage lung cancer
2012, Annals of Thoracic SurgeryCitation Excerpt :Wedge resection is frequently employed for diagnostic purposes in this setting, and is readily accomplished with a VATS approach [25]. However, VATS wedge resection may not be feasible for small, non-palpable lesions [26], and does not represent the ideal surgical approach for definitive management of non-small cell lung cancer, necessitating completion of a higher order anatomic lung resection (eg, segmentectomy or lobectomy) [8, 27]. The use of an anatomic sublobar resection technique (anatomic segmentectomy) can overcome each of these limitations by accomplishing a complete, anatomic resection of the targeted nodule, providing both definitive diagnosis and therapy.
In-hospital clinical and economic consequences of pulmonary wedge resections for cancer using video-assisted thoracoscopic techniques vs traditional open resections: A retrospective database analysis
2012, ChestCitation Excerpt :In addition, the visual analog pain score on postoperative day 6 was significantly less at 26.5 ± 11.6 in the VATS group compared with 48.3 ± 12.8 in the lateral thoracotomy group (P < .05). Swanson and colleagues14 confirmed the sensitivity and specificity of thoracoscopic resection of solitary pulmonary nodules approaches, reporting 100% in their prospective series of 65 patients. Chang and colleagues15 reported on 62 ambulatory patients with indeterminate pulmonary nodules or interstitial lung disease undergoing thoracoscopic lung biopsy between June 2000 and June 2001.
The Role of VATS for Staging and Diagnosis in Patients with Non-Small Cell Lung Cancer
2007, Seminars in Thoracic and Cardiovascular SurgeryCitation Excerpt :The visual analog pain score on postoperative day 6 was significantly less at 26.5 ± 11.6 in the VATS group compared with 48.3 ± 12.8 in the lateral thoracotomy group (P <0.05). Swanson and colleagues16 confirmed the sensitivity and specificity of thoracoscopic resection of solitary pulmonary nodules approaches 100% in their report on a prospective series of 65 patients. Jiménez17 and fellow members of the Spanish Video-Assisted Thoracic Surgery Study Group reported on the prospective study of 209 cases of VATS resection of pulmonary nodules at 17 member hospitals between January 1996 and January 1998.
Outcomes of Sublobar Resection Versus Lobectomy for Stage I Non-Small Cell Lung Cancer: A 13-Year Analysis
2006, Annals of Thoracic SurgerySolitary pulmonary metastasis presenting 20 years after primary resection of Wilms tumor
2005, Mayo Clinic ProceedingsCitation Excerpt :Approximately one half of uncalcified solitary pulmonary nodules are malignant.16 Although most of these malignant lesions are primary lung cancers, solitary metastases have accounted for up to 23% of resected solitary pulmonary nodules, with the breast and the colon representing the most common primary sites of origin.17 The likelihood of malignancy increases with the size of the pulmonary nodule.
Public health aspects of dirofilariasis in the United States
2005, Veterinary Parasitology