To investigate the contribution of video-assisted thoracoscpoic surgery (VATS) as part of an aggressive approach to the diagnosis and treatment of patients presenting with solitary pulmonary nodules (SPNs).
A retrospective chart review was performed to evaluate the outcome of solitary pulmonary nodules recommended for VATS from January 2002 through January 2003. A SPN was defined as a lung parenchymal lesion measuring 3 cm or less and no tissue diagnosis prior to surgery. Standard VATS techniques were used under general anesthesia. A wedge resection was performed, yiedling a frozen section, the pathology of which determined proceeding to lobectomy vs termination of the procedure in cases of benign nodules or advanced disease.
52 patients with a diagnosis of a solitary pulmonary nodule were recommended for VATS. 35 malignancies were diagnosed, constituting a 67 percent yeild of malignancy for SPNs. Two conversions were necessary due to nodule size and location in one patient and an inability to perform single-lung ventilation in the second patient. One complication, stable atrial fibrillation, occurred on post-operative day one in a patient who underwent VATS only. The most common benign lesion was a granuloma, which in 5 of 7 patients PET scanning was positive.CONCLUSIONS: VATS is a safe procedure, with a 100% diagnostic yield. When there is a high clinical suspicion based on a patient’s medical history, tobacco use, current medical condition and PET scan results, VATS biopsy yields a high rate of malignancy.
VATS is an integral part of the armamentarium for definitive diagnosis and treatment of lung nodules. It allows early intervention in the SPN, which in our experience is often a malignancy. Further investigation of the confounding value of PET scanning in the subset of patients with granulomatous disease is warranted.
Number of CasesNodule Size(mm)PET Scan +PET Scan −VATS only211390Benign151370Malignant61620VATS + lobectomy3119154Benign21801Malignant2919153
L.T. Withers, None.