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The Annals of Thoracic Surgery, Vol 56, 825-830, Copyright © 1993 by The Society of Thoracic Surgeons
MJ Mack, SR Hazelrigg, RJ Landreneau and TE Acuff
Traditional nonoperative diagnostic approaches to the indeterminate
solitary pulmonary nodule include bronchoscopy and percutaneous needle
biopsy. Although both methods are minimally invasive, the diagnosis of the
small, peripheral nodule may remain elusive. Open thoracotomy is often
required when these methods fail to obtain a diagnosis. Between January
1991 and June 1992, 242 patients with indeterminate solitary lung nodules
underwent thoracoscopic excisional biopsy as the primary diagnostic method.
Wedge excisions of the nodules were all performed by thoracoscopic
techniques using an endoscopic stapler alone (72%),
neodymium:yttrium-aluminum garnet laser (18%), or both (10%). A definite
diagnosis was obtained in all patients. Two patients required conversion to
thoracotomy to locate the nodule (both malignant). A benign diagnosis was
obtained in 127 patients (52%) and a malignant diagnosis in 115 (48%). Of
the malignant nodules, 51 (44%) were primary lung cancer and 64 (56%) were
metastases. All patients diagnosed with primary lung cancer having adequate
pulmonary reserve (n = 29) underwent formal open lung resection during the
same procedure. There was no mortality, and significant morbidity was
limited to atelectasis in 3 patients (1.2%), pneumonia in 2 patients
(0.8%), and prolonged air leak more than 7 days in 4 patients (1.6%).
Average hospital stay for patients having thoracoscopy only (n = 213) was
2.4 days (range, 1 to 12 days). Thoracoscopy offers a minimally invasive
approach for the diagnosis of the indeterminate solitary nodule. It has
advantages over traditional diagnostic methods of being virtually 100%
sensitive and 100% specific with no mortality and minimal
morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Thoracoscopy for the diagnosis of the indeterminate solitary pulmonary nodule
Section of Thoracic Surgery, Medical City Dallas, Texas.
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