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Ann Thorac Surg 1991;51:465-469
© 1991 The Society of Thoracic Surgeons

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Articles

Computed tomography-guided minithoracotomy for the resection of small peripheral pulmonary nodules

Departments of Surgery, Medicine, and Radiology, the New England Medical Center and the Boston Veteran's Administration Medical Center, Boston, Massachusetts USA

Accepted for publication November 28, 1990.

^_* Address reprint requests to Dr Daly, Department of Cardiothoracic Surgery, New England Medical Center Hospital, 750 Washington St, Boston, MA 02111.

Small peripheral pulmonary nodules ranging in size from 1 mm to 20 mm were excised in 58 patients. Computed tomography was used to mark the skin overlying the nodules to minimize the surgical exposure needed for operative identification. The nodules were 1 cm or less in maximum diameter in 76% of the patients. Twenty-six patients had single nodules and 32 patients had multiple nodules. The preoperative diagnosis was inaccurate in 67% of the patients. In 61% of the patients in whom malignancy was suspected, no tumor was demonstrated. Conversely, of the 20 patients in whom a malignant nodule was excised, the preoperative diagnosis was correct in only 50%. Thirty-one patients required no further treatment apart from their biopsy and 27 required additional intervention. Small peripheral pulmonary nodules require biopsy for diagnosis. When percutaneous needle aspiration biopsy is unsuccessful, or technically difficult, a computed tomography-guided thoracotomy is an effective and minimally invasive surgical alternative.

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