Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
Jpn J Clin Oncol. 2011 Aug;41(8):1017-22. doi: 10.1093/jjco/hyr073. Epub 2011 Jun 21.
The safety and efficacy of surgical resection of lung nodule without tissue diagnosis is controversial. We evaluated direct surgical resection of highly suspicious pulmonary nodules and the clinical and radiological predictors of malignancy.
Retrospective analyses were performed on 113 patients who underwent surgical resection without prior tissue diagnosis for highly suspicious pulmonary nodules. Clinical and radiological characteristics were compared between histologically proven benign and malignant nodules after resection. Total costs, length of hospitalization and waiting time to surgery were compared with those of patients who had tissue diagnosis prior to surgery.
Among 280 patients with pulmonary nodules suspicious for lung cancer, 113 (40.4%) underwent operation without prior tissue diagnosis. Lung nodules were diagnosed as malignant in 96 (85%) of the 113 patients. Except for forced expiratory volume in 1 s, clinical characteristics were not significantly different according to the pathologic results. Forty-five (90%) of 50 patients with ground-glass opacity nodules had a malignancy. Mixed ground-glass opacity, bubble lucency, irregular margin and larger size correlated with malignancy in ground-glass opacity nodules (P<0.05). Fifty-one (81%) of 67 patients with solid nodules had a malignancy. Spiculation, pre-contrast attenuation and contrast enhancement significantly correlated with malignancy in solid nodules (P<0.05). Surgical resection without tissue diagnosis significantly decreased total costs, hospital stay and waiting time (P<0.05).
Direct surgical resection of highly suspicious pulmonary nodules can be a valid procedure. However, careful patient selection and further investigations are required to justify direct surgical resection.
对于未经组织诊断的肺结节进行手术切除的安全性和有效性存在争议。我们评估了对高度疑似肺结节直接进行手术切除的效果，并分析了恶性肿瘤的临床和影像学预测因子。
对 113 例因高度疑似肺结节而未进行术前组织诊断即接受手术切除的患者进行回顾性分析。比较切除后组织学证实为良性和恶性结节的临床和影像学特征。比较了直接手术切除组与术前有组织学诊断组的总费用、住院时间和手术等待时间。
在 280 例疑似肺癌的肺结节患者中，有 113 例（40.4%）未进行术前组织诊断即接受了手术。113 例患者中，有 96 例（85%）诊断为恶性。除 1 秒用力呼气量外，根据病理结果，临床特征无明显差异。50 例磨玻璃密度结节患者中，有 45 例（90%）为恶性。磨玻璃密度结节中，纯磨玻璃密度、泡状透亮影、不规则边缘和较大的结节大小与恶性肿瘤相关（P<0.05）。67 例实性结节患者中，有 51 例（81%）为恶性。实性结节中，分叶征、平扫时的衰减程度和增强扫描后的强化程度与恶性肿瘤显著相关（P<0.05）。未经组织诊断即直接进行手术切除可显著降低总费用、住院时间和手术等待时间（P<0.05）。
对于高度疑似肺结节，直接进行手术切除是一种有效的治疗方法。但是，需要仔细选择患者，并进一步进行检查以证明直接手术切除的合理性。
