Division of Cardiothoracic Surgery, Department of Surgery, Li Ka Sing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China.
Eur J Cardiothorac Surg. 2013 Aug;44(2):231-7; discussion 237. doi: 10.1093/ejcts/ezs671. Epub 2013 Jan 8.
Patients with a suspicious lung mass sometimes receive surgery with no preoperative tissue diagnosis despite-and sometimes in lieu of-modern medical investigations. The pros and cons of doing so have rarely been studied.
Pulmonary surgery was performed in 443 consecutive adult patients with a lung mass confirmed or suspected to be an early stage primary lung cancer. No diagnosis was confirmed preoperatively in 206 (46.5%) patients. Whether to take a core biopsy or wedge excision biopsy for frozen section assessment intraoperatively was decided at the surgeon's discretion.
Patients without preoperative diagnosis were on average younger than those with a diagnosis (61 vs 66 years, P < 0.01), but were otherwise similar to those who had a preoperative diagnosis confirmed. In all patients operated on without a preoperative diagnosis, there was no mortality or major complication, and the perioperative minor morbidity rate was 9.7%. Among patients ultimately found to have lung cancer and who received a lobectomy, performing a frozen section intraoperatively did not increase mean operation time or morbidity. Among those patients with no preoperative tissue diagnosis, 97 (47.1%) proceeded to surgery without attempts at preoperative diagnosis, and 109 (52.9%), after attempts at preoperative diagnosis failed to yield a positive diagnosis. After surgery, benign disease was found in 16 (7.8%) patients without preoperative diagnosis. A significantly lower proportion of patients without preoperative diagnosis waited an interval of over 28 days between presentation and being accepted for thoracic surgery (42.2 vs 54.9%, P < 0.01). However, they were not more likely to have Stage I disease and did not have better recurrence-free survival rates on survival analysis.
Proceeding to surgery without preoperative diagnosis in selected patients with a suspicious lung mass is safe and can potentially reduce the interval between presentation and surgical management. However, the shortened workup time is not associated with improved surgical or oncological outcomes.
尽管现代医学检查手段不断发展，但对于疑似肺部肿块的患者，有时仍会进行无术前组织诊断的手术，而不是选择进行这种手术。目前很少有研究探讨这种做法的优缺点。
对 443 例连续就诊的成年肺部肿块患者进行了肺切除术，这些患者的肺部肿块经证实或怀疑为早期原发性肺癌。206 例（46.5%）患者术前未明确诊断。术中是否进行核心活检或楔形切除活检进行冰冻切片评估由外科医生决定。
无术前诊断的患者平均年龄小于有术前诊断的患者（61 岁比 66 岁，P < 0.01），但与有术前确诊的患者其他方面相似。在所有未行术前诊断而接受手术的患者中，无死亡或严重并发症，围手术期轻微发病率为 9.7%。在最终诊断为肺癌且接受肺叶切除术的患者中，术中进行冰冻切片并未增加平均手术时间或发病率。在无术前组织诊断的患者中，97 例（47.1%）未尝试术前诊断即进行手术，109 例（52.9%）尝试术前诊断但未获得阳性诊断后进行手术。术后，16 例（7.8%）无术前诊断的患者发现良性疾病。与有术前诊断的患者相比，无术前诊断的患者从就诊到接受胸外科手术的间隔时间超过 28 天的比例显著更低（42.2%比 54.9%，P < 0.01）。然而，他们更不可能患有 I 期疾病，且在生存分析中无更好的无复发生存率。
对于可疑肺部肿块的特定患者，在无术前诊断的情况下进行手术是安全的，可能会缩短从就诊到手术管理的时间间隔。然而，缩短检查时间与手术或肿瘤学结局的改善无关。
