Institutional report - Thoracic general Solitary pulmonary nodules: pathological outcome of 150 consecutively resected lesions (original) (raw)
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Solitary pulmonary nodules: pathological outcome of 150 consecutively resected lesions
Interactive cardiovascular and thoracic surgery, 2005
We investigated the pathological outcome of lung resections undertaken for solitary pulmonary nodules (SPNs) <30 mm in diameter in a regional thoracic practice serving a population historically engaged in heavy and light industry together with high tobacco use. Analysis of data collected prospectively on patients undergoing open lung resection between 1998 and 2003 for SPNs <30 mm in diameter. Demographics, operative and pathological details were sought from files and electronic records. One hundred and fifty patients (80 men), underwent lung resection during the study period. Mean age at resection was 64.7 years. Mean nodule diameter was 17.6 mm as measured by CT. Eighty-seven lobectomies, nine bilobectomies, 51 wedge excisions and one pneumonectomy were performed via open approaches. Frozen section was used selectively and anatomical resection performed where feasible. Malignancy was identified in 115 patients (77.7%): 97 (65.5%) with primary lung pathology; 18 (12.2%) had m...
The follow-up of solitary pulmonary nodules at Mater Dei Hospital
2019
Background: Solitary pulmonary nodules (SPNs) are a common incidental radiological finding, occurring in 28% of smokers, 20% of ex-smokers and 36% of non-smokers.1 These nodules represent a diagnostic challenge. Under-evaluation may delay the diagnosis of early lung cancer whilst over-evaluation may increase expenditure, radiation and also patient concern.2 The aim of this audit was to evaluate whether the Fleischner Society Guidelines 3 are adhered to in the follow-up of SPNs locally. Methodology: This retrospective study includes all SPNs diagnosed incidentally on Computed Tomography (CT) between January 2013 and December 2014, excluding patients with a history of malignancy. The follow-up of the nodules was compared with Fleischner Society Recommendations (FSR) as the gold standard. Standard Use: FSR 2005, which stratify nodules based on size and smoking history. Results: From a cohort of 100 patients, guideline-concordant care was found in 29%. SPNs were under-evaluated in 36% ...
European Journal of Surgical Oncology (EJSO), 2013
Background: The present study was carried out to evaluate the characteristics of solitary pulmonary nodule (SPN) in patients with previous cancer(s) and to analyse the outcome of its surgical treatment. Methods: We retrospectively analysed 131 patients with history of previous malignancy submitted to lung surgery for new identified SPN between January 2004 and December 2009. Results: The diagnosis was metastasis in 65 patients, primary lung cancer in 57, benign lesion in 9. Primary lung cancers were significantly larger, had higher maxSUV at CT-PET scanning, occurred after a longer disease-free interval in patients older and with worse lung function when compared with metastatic lesions. Overall survival at 5-year was 67% for benign lesions, 62% for primary lung cancer, 48% for metastatic disease. Histological subtype, SPN diameter less than 2 cm and DFI >36 months were factors influencing long-term prognosis of metastatic patients. Histological subtype and pathological staging were factors influencing long-term outcome of primary lung cancer patients. Discussion: Surgical resection of solitary pulmonary nodule is essential in patients with history of previous cancer to rule out benign lesions, to offer diagnostic confirmation and local control of the disease in metastatic tumours and to correctly stage and treat primary lung cancer.
Management of solitary pulmonary nodule
European Journal of Cardio-Thoracic Surgery, 2008
The pulmonary nodule is an important diagnostic and therapeutic problem. Diagnostic certainty is only obtained by histological examination. Mini-invasive surgery allows removal of the nodule with minimal sequelae for the patient. Methods: From October 1991 to December 2006, 370 resections for a pulmonary nodule were performed at our Department of General Surgery of the University of Milan: 276 wedge resections and 94 lobectomies. Results: Frozen section was performed in all the wedge resections, and in the presence of cancer (77 cases), whenever possible (61 cases), the intervention was converted to lobectomy in the same session. In the other 94 cases, the nodule was removed by lobectomy due to the impossibility of performing a wedge resection. Conclusions: Despite the refinement of diagnostic techniques, only exeresis of a pulmonary nodule ensures a definitive diagnosis, thus resolving the problem of benign pathologies and initiating the correct therapy for malignant lesions in the same session. #
IP innovative publication pvt. ltd, 2019
Background: The diagnosis, classification and management of a solitary pulmonary nodule (SPN) have always been a challenge for the clinicians and radiologists. All SPNs should be considered malignant until proven otherwise. Malignancy risk rises with increasing nodule size. Hence evaluation of the various clinical and pathological presentations of SPN is essential. Methodology: A hospital-based cross-sectional study was conducted in a tertiary care teaching hospital on 70 cases of SPN. Chest X-ray, CT (Computed Tomography) and bronchoalveolar lavage were used for analysing the SPN. IBM SPSS version 22 was used for statistical analysis. Results: The incidence of SPN in this study was 1.33 per 1000 population. The total number of chest X-rays screened were 5263. The most common risk factors were exposure to PTB (Pulmonary Tuberculosis) or history of PTB (97.1%), followed by smoking (81.4%), history of STD (32.9%). Dry cough was the most common symptom among (20%). In X-ray, in 57.1% of subjects, the upper lobes were involved. Lesions were central in 41.4% while peripheral in 58.6%. The proportion of nodules with 1.1 to 2cm and above 2 cm was 22.85% and 77.15%. No calcification was found in 78.6% of nodules. In SPN the most common final diagnosis was tuberculosis (14.3%) followed by Pneumonia/abscess (8.6%) and Squamous cell carcinoma and Pseudotumor (5.71% each). 20% of SPN were malignant. 11.42% of nodules turned out to be primary lung malignancy while 1.42% were metastasis and 7.1% were small cell carcinoma. Conclusions: SPN is a common incidental and radiologic finding. Some internal features of SPNs can help in differentiating benign from malignant lesions. Despite radiological imaging, still, a large number of nodules have to be described as “indeterminate” and advanced and often more invasive techniques are needed for further work-up. Keywords: Solitary pulmonary nodule (SPN); Malignancy, Incidence; Bronchoalveolar lavage.
Evaluation of Patients With Pulmonary Nodules: When Is It Lung Cancer?
Chest, 2007
Background: Pulmonary nodules are spherical radiographic opacities that measure up to 30 mm in diameter. Nodules are extremely common in clinical practice and challenging to manage, especially small, "subcentimeter" nodules. Identification of malignant nodules is important because they represent a potentially curable form of lung cancer. Methods: We developed evidence-based clinical practice guidelines based on a systematic literature review and discussion with a large, multidisciplinary group of clinical experts and other stakeholders. Results: We generated a list of 29 recommendations for managing the solitary pulmonary nodule (SPN) that measures at least 8 to 10 mm in diameter; small, subcentimeter nodules that measure < 8 mm to 10 mm in diameter; and multiple nodules when they are detected incidentally during evaluation of the SPN. Recommendations stress the value of risk factor assessment, the utility of imaging tests (especially old films), the need to weigh the risks and benefits of various management strategies (biopsy, surgery, and observation with serial imaging tests), and the importance of eliciting patient preferences. Conclusion: Patients with pulmonary nodules should be evaluated by estimation of the probability of malignancy, performance of imaging tests to characterize the lesion(s) better, evaluation of the risks associated with various management alternatives, and elicitation of patient preferences for treatment.
European Radiology, 2014
Objective To determine the prevalence of solitary pulmonary nodules (SPNs) in chest radiology studies and patient's features associated with malignancy in a non-high-risk clinical population. Methods Patients ≥35 years were referred for thoracic imaging in two hospitals (2010-2011). Eight radiologists determined the presence and characteristics of SPN. Selected variables were collected from radiological register and medical records. Observer agreement in the diagnosis of SPN was assessed. Results 25,529 patients were included: 23,102 (90.5 %) underwent chest radiograph and 2,497 (9.5 %) a CT. The prevalence of SPN was 2.1 % (95 % CI 1.9-2.3) in radiographs and 17.0 % (95 % CI 15.5-18.5) in CT. In patients undergoing chest radiograph, detection of SPN with an irregular border was more frequent among smokers. In patients who had a CT, larger SPNs appeared to be associated with 60 years of age or over, diagnosis of a respiratory illness, or male gender. In addition, an irregular border was also more common among men. Conclusions The prevalence of SPNs detected by both radiograph and CT was lower than that shown in screening studies. Patient characteristics such as age, sex, respiratory disease, or smoking habit were associated with nodule characteristics that are known to be related with malignancy. Key Points • There is a lower SPN prevalence in the clinical population than in screening studies. • SPN prevalence is associated with some patient characteristics: sex, age, imaging test. • Nodule characteristics related to malignancy were associated with some patient characteristics.