PURPOSE: To determine whether there has been a change in the prevalence of malignancy among resected, indeterminate pulmonary lesions over the past 25 years.
METHODS: Retrospective review of all surgical resections (pneumonectomy, lobectomy, or wedge) for indeterminate pulmonary lesions from 1981 through March 2006 at our university-affiliated VA Medical Center.
RESULTS: Of the 1249 patients (undergoing 1336 procedures), virtually all were men with an average age of 64.7 + 11 yrs. The average lesion diameter was 3.1 + 2.0 cm; 61% were 3 cm or less. Overall, 86.1% of resected lesions were malignant; 93.4% of these were bronchogenic carcinomas. Of the benign lesion, more than 85% were granulomas. The proportion of malignant diagnoses increased from 65 -70% in 1981 -1983, to 85-100% from 1990 through 2005. However, a recent increase in benign resected lesions was noted, with 18%, 27%, and 50% of lesions resected in the past 12, 6, and 3 months, respectively, yielding benign diagnoses. Of the 7 patients with benign resected lesions in the past 12 months, 4 had granulomas, 2 had focal fibrosis, and 1 had focal organizing pneumonia. All but one benign lesion had significant fluoro-18-deoxyglucose positron emission (FDG-PET) uptake (>2.5 standardized uptake value) on scans prior to surgery.
CONCLUSION: We conclude that at our institution there was a striking increase in the prevalence of malignancy among resected indeterminate pulmonary lesions from the early 1980s until the 1990s that has largely been sustained over the past decade. However, we note a recent increase in numbers of benign lesions resected in the past year. This may represent statistical variation, but may also reflect our increased reliance on FDG-PET scans when deciding whether to resect indeterminate pulmonary lesions.
CLINICAL IMPLICATIONS: If a recent trend towards resection of more benign pulmonary lesions is confirmed, we would caution clinicians to reassess the utility of FDG-PET scans in defining which patients need surgical resection of indeterminate pulmonary lesions.
DISCLOSURE: Jeffrey Rubins, None.