New Publications at the Allegheny Center for Lung and Thoracic Disease

Diagnosing the indeterminate pulmonary nodule: percutaneous biopsy versus thoracoscopy.

Mitruka S, Landreneau RJ, Mack MJ, Fetterman LS, Gammie J, Bartley S, Sutherland
SR, Bowers CM, Keenan RJ, Ferson PF, et al

BACKGROUND. The malignant potential of indeterminate solitary pulmonary nodules (SPN) mandates accurate diagnostic management.
METHODS. 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.
RESULTS. 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.
CONCLUSIONS. 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.

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