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Abstract: Slide Presentations |

Video-Assisted Thoracoscopy as a Primary Modality Is Safe, Efficient, and 100% Accurate in the Diagnosis of Solitary Pulmonary Nodules FREE TO VIEW

Laura T. Withers, MD; Benjamin H. Han, BA; Cliff P. Connery, MD; Karen McGinnis, MD; Robert C. Ashton, MD
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St Luke’s Roosevelt Hospital, Columbia University, College of Physicians & Surgeons, New York, NY


Chest


Chest. 2003;124(4_MeetingAbstracts):75S. doi:10.1378/chest.124.4_MeetingAbstracts.75S-a
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Abstract

PURPOSE:  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).

METHODS:  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.

RESULTS:  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.

CLINICAL IMPLICATIONS:  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

DISCLOSURE:  L.T. Withers, None.

Monday, October 27, 2003

8:00 AM - 9:30 AM


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