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Original Articles: General Thoracic

Invited Commentary

Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115

(Email: sjswanson{at}partners.org).

The article by Nakashima and colleagues [1] is a very important contribution to our armamentarium regarding the diagnosis and treatment of small lung nodules. This is a burgeoning problem with the change in epidemiology of lung cancer and the ubiquity of chest computed tomography scans. Clearly, we are curing smaller, screening-detected-type lung cancers with a much higher rate than those that are picked up once symptoms occur. This gives all of us who treat patients with lung cancer much about which to be optimistic.

However, we are faced with how best to handle the management of these small nodules. If they are malignant, we want to resect them as early as possible to give the highest chance of cure, as noted by Henschke and colleagues in the New England Journal of Medicine [2]. Although it is an uncommon situation, some of these small lesions can be difficult to identify in the operating room, making biopsy challenging. The method described by Nakashima and colleagues appears to be safe and effective.

Going forward, it would be useful to conduct a prospective trial to better characterize the details of the lesions that are most benefited by this approach. Centrally located ground glass lesions in areas of the lung that are not amenable to a simple segmental resection (ie, basilar lower lobe) may be the ones most likely to need such an approach. Before widely applying this type of procedure, we need to carefully analyze its utility given the economic constraints that are upon us all in medicine.

	References

Top References

 

1. Nakashima S, Watanabe A, Obama T, Yamada G, Takahashi H, Higami T. Need for preoperative computed tomography-guided localization in video-assisted thoracoscopic surgery pulmonary resections of metastatic pulmonary nodules Ann Thorac Surg 2010;89:212-219.[Abstract/Free Full Text]
2. Henschke CI, Yankelevitz DF, Libby DM, Pasmantier MW, Smith JP, Miettinen OS, International Early Lung Cancer Action Program Investigators Survival of patients with stage I lung cancer detected on CT screening N Engl J Med 2006;355:1763-1771.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Scott Swanson Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Swanson, S. Search for Related Content PubMed PubMed Citation Articles by Swanson, S. Related Collections Lung - cancer Related Article