Management of solitary pulmonary nodules. How to decide when resection is required.

Although each case must be considered individually, there are several basic principles of management in cases of solitary pulmonary nodules: Every nodule must be regarded as potentially malignant until proven otherwise. Malignant nodules should be resected unless the procedure is contraindicated because of an unacceptably high surgical risk or evidence of metastasis. Resection of a benign nodule rarely benefits the patient and carries a small but significant mortality risk. Ruling out malignancy by less-invasive means than thoracotomy is desirable wherever possible. A management decision should be reached with reasonable promptness once a solitary pulmonary nodule has been detected. Under certain circumstances, a decision to observe the nodule for a period of time with serial chest films may be appropriate, but this must be a considered approach and not a "default" position.