Ozeki Naoki, Iwano Shingo, Taniguchi Tetsuo, Kawaguchi Koji, Fukui Takayuki, Ishiguro Futoshi, Fukumoto Koichi, Nakamura Shota, Hirakawa Akihiro, Yokoi Kohei
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Interact Cardiovasc Thorac Surg. 2014 Nov;19(5):830-7. doi: 10.1093/icvts/ivu233. Epub 2014 Jul 18.
With the recent improvements in the diagnostic accuracy of radiographic modalities, it might be an option to perform therapeutic surgery without a definitive diagnosis for selected patients with suspected lung cancer based on the findings of diagnostic imaging.
Between April 2008 and December 2012, all nodules without a definitive diagnosis were classified into five categories according to the probability of lung cancer based on the diagnostic imaging: Category 1 (Benign), Category 2 (Probably benign), Category 3 (Intermediate), Category 4 (Suspected malignancy) and Category 5 (Highly suggestive of malignancy). In this study, the 232 surgical candidates for suspected clinical stage I lung cancer without a preoperative definitive diagnosis were considered to be Category 3 (n = 29), Category 4 (n = 46) and Category 5 (n = 157). Eighty-two patients (72% of Category 3, 46% of Category 4 and 25% of Category 5) had an intraoperative diagnosis during surgery, whereas the remaining 150 patients did not. The final pathological diagnosis and surgical outcomes were analysed.
The final pathological diagnosis of the 232 suspicious nodules revealed 214 lung cancers (52% of Category 3, 93% of Category 4 and 99% of Category 5). Wedge resection was performed for all seven benign tumours. In the multiple regression analysis, intraoperative diagnosis was a significant factor for the length of the operation. In the multivariate logistic regression analysis, the length of the operation was a significant factor predicting both the postoperative morbidity and a prolonged hospital stay.
Based on a careful clinical decision made using the current diagnostic imaging strategies, patients with a high probability of lung cancer are good candidates for therapeutic surgery, even without a preoperative or intraoperative definitive diagnosis.
随着近期放射影像学检查诊断准确性的提高，对于部分根据诊断性影像学检查结果怀疑患有肺癌的患者，在未明确诊断的情况下进行治疗性手术可能是一种选择。
在2008年4月至2012年12月期间，所有未明确诊断的结节根据诊断性影像学检查结果对肺癌的可能性分为五类：1类（良性）、2类（可能良性）、3类（中间型）、4类（疑似恶性）和5类（高度提示恶性）。在本研究中，232例疑似临床I期肺癌且术前未明确诊断的手术候选患者被归类为3类（n = 29）、4类（n = 46）和5类（n = 157）。82例患者（3类的72%、4类的46%和5类的25%）在手术中有术中诊断，而其余150例患者没有。分析了最终病理诊断和手术结果。
232个可疑结节的最终病理诊断显示214例肺癌（3类的52%、4类的93%和5类的99%）。对所有7例良性肿瘤均进行了楔形切除术。在多元回归分析中，术中诊断是手术时间的一个重要因素。在多因素逻辑回归分析中，手术时间是预测术后发病率和住院时间延长的一个重要因素。
基于使用当前诊断性影像学策略做出的谨慎临床决策，即使没有术前或术中明确诊断，肺癌可能性高的患者也是治疗性手术的良好候选者。
