Mitruka S, Landreneau R J, Mack M J, Fetterman L S, Gammie J, Bartley S, Sutherland S R, Bowers C M, Keenan R J, Ferson P F
Department of Surgery, School of Dentistry, University of Pittsburgh, PA 15213, USA.
Surgery. 1995 Oct;118(4):676-84. doi: 10.1016/s0039-6060(05)80035-2.
The malignant potential of indeterminate solitary pulmonary nodules (SPN) mandates accurate diagnostic management.
613 patients undergoing either computed tomographic lung biopsy (CT-Bx) (n = 312) or thoracoscopic excisional biopsy (Thor-Bx) (n = 301) for the diagnosis of SPN were evaluated for relative accuracy, complications, and effect on clinical treatment.
CT-Bx identified a malignant diagnosis (Dx) in 201 (64%) of 312 patients; 85 (42%) underwent operations. A total of 116 patients (58%) with synchronous cancer (n = 16), impaired physiologic condition, or unresectable lesions (n = 100) were not operated. Surgical treatment was deferred for 20 patients (6%) with a "specific benign" Dx and 44 physiologically impaired patients with "nonspecific benign" CT-Bx. Forty-seven patients with "nonspecific benign" Dx underwent operation. Thirty-two (68%) lesions were malignant (4 metastatic, 28 primary cancer). CT-Bx accuracy was 86% for malignant and 79 (71%) of 111) for benign lesions. Surgery was still required for 132 (82%) of 163 patients with resectable lesions. Complications occurred in 24% of patients. A specific benign or malignant Dx was obtained in 292 (96%) of 301 patients undergoing Thor-Bx. Conversion to thoracotomy for lobectomy occurred in 38 (21%) of 179 patients with lung cancer. One hundred forty-one patients with lung cancer and impaired physiologic condition and all patients with metastatic (n = 44) and benign lesions (n = 78) had thoracoscopic resection alone. Complications occurred in 22% of patients.
Limited accuracy for benign Dx with CT-Bx requires surgical biopsy for patients with SPN with adequate physiologic reserve. Thor-Bx is a safe and accurate minimally invasive surgical approach to resectable peripheral SPN.
不确定的孤立性肺结节（SPN）的恶性潜能要求进行准确的诊断管理。
对613例因诊断SPN而接受计算机断层扫描肺活检（CT-Bx）（n = 312）或胸腔镜切除活检（Thor-Bx）（n = 301）的患者进行了相对准确性、并发症及对临床治疗影响的评估。
CT-Bx在312例患者中的201例（64%）中确诊为恶性；85例（42%）接受了手术。共有116例（58%）伴有同步癌（n = 16）、生理状况受损或病变不可切除（n = 100）的患者未接受手术。20例（6%）诊断为“特定良性”的患者以及44例生理状况受损且CT-Bx诊断为“非特定良性”的患者手术治疗被推迟。47例诊断为“非特定良性”的患者接受了手术。32例（68%）病变为恶性（4例转移，28例原发性癌）。CT-Bx对恶性病变的准确率为86%，对良性病变的准确率为79例（111例中的71%）。163例可切除病变患者中的132例（82%）仍需要手术。24%的患者发生了并发症。301例接受Thor-Bx的患者中有292例（96%）获得了特定的良性或恶性诊断。179例肺癌患者中有38例（21%）转为开胸肺叶切除术。141例肺癌且生理状况受损的患者以及所有转移（n = 44）和良性病变（n = 78）的患者仅接受了胸腔镜切除术。22%的患者发生了并发症。
CT-Bx对良性诊断的准确性有限，对于具有足够生理储备的SPN患者需要进行手术活检。Thor-Bx是一种安全、准确的微创外科手术方法，用于可切除的周围型SPN。
