Sun Mi Choi1, Eun Young Heo2, Jinwoo Lee1, Young Sik Park1, Chang-Hoon Lee1, Chang Min Park3, Chang Hyun Kang4, Jae-Joon Yim1, Young Tae Kim4, Chul-Gyu Yoo1, Sung Koo Han1, Young Whan Kim1. 1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea. 2. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea. 3. Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea. 4. Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
Abstract
BACKGROUND AND AIMS: The solitary pulmonary nodule (SPN) is a common clinical problem usually detected incidentally during screening tests for lung cancer. Video-assisted thoracoscopic surgery (VATS) is performed for diagnosing SPNs when there are technical difficulties with transthoracic needle aspiration biopsy or bronchoscopic biopsy, inconclusive biopsy results, or when there is a high suspicion of malignancy. This study aimed to identify factors that can reduce unnecessary VATS for the diagnosis of SPNs. METHODS: We retrospectively analysed patients with SPNs (n = 107) who had undergone diagnostic VATS at Seoul National University Hospital from January 2007 to December 2008. Clinical and radiological parameters were evaluated to compare benign and malignant SPNs. RESULTS: Benign SPNs were diagnosed in 31 patients (29.0%). The most common reason for patients to undergo a diagnostic VATS was a history of malignancy. The most common histological findings in patients with benign SPNs were non-specific inflammatory lesions (29.0%) and tuberculosis (16.1%). The presence of respiratory symptoms was significantly associated with benign diseases [P = 0.004, odds ratio (OR) 0.189, 95% confidence interval (CI) 0.060-0.590], and part-solid nodules were significantly related to malignancy (P = 0.026, OR 6.34, 95% CI 1.248-32.169). CONCLUSION: Approximately 30% of SPNs resected by VATS were benign. Although we did not identify a definite factor for predicting benign disease or malignancy, the presence of respiratory symptoms was related to benign disease, and part-solid nodules were associated with malignancy.
BACKGROUND AND AIMS: The solitary pulmonary nodule (SPN) is a common clinical problem usually detected incidentally during screening tests for lung cancer. Video-assisted thoracoscopic surgery (VATS) is performed for diagnosing SPNs when there are technical difficulties with transthoracic needle aspiration biopsy or bronchoscopic biopsy, inconclusive biopsy results, or when there is a high suspicion of malignancy. This study aimed to identify factors that can reduce unnecessary VATS for the diagnosis of SPNs. METHODS: We retrospectively analysed patients with SPNs (n = 107) who had undergone diagnostic VATS at Seoul National University Hospital from January 2007 to December 2008. Clinical and radiological parameters were evaluated to compare benign and malignant SPNs. RESULTS: Benign SPNs were diagnosed in 31 patients (29.0%). The most common reason for patients to undergo a diagnostic VATS was a history of malignancy. The most common histological findings in patients with benign SPNs were non-specific inflammatory lesions (29.0%) and tuberculosis (16.1%). The presence of respiratory symptoms was significantly associated with benign diseases [P = 0.004, odds ratio (OR) 0.189, 95% confidence interval (CI) 0.060-0.590], and part-solid nodules were significantly related to malignancy (P = 0.026, OR 6.34, 95% CI 1.248-32.169). CONCLUSION: Approximately 30% of SPNs resected by VATS were benign. Although we did not identify a definite factor for predicting benign disease or malignancy, the presence of respiratory symptoms was related to benign disease, and part-solid nodules were associated with malignancy.