title: Diagnosing the indeterminate pulmonary nodule: percutaneous biopsy versus thoracoscopy.
abstract: 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.
authors.affiliation: Department of Surgery, School of Dentistry, University of Pittsburgh, PA 15213, USA.
authors.forename: S
authors.initials: S
authors.lastname: Mitruka
authors.forename: R J
authors.initials: RJ
authors.lastname: Landreneau
authors.forename: M J
authors.initials: MJ
authors.lastname: Mack
authors.forename: L S
authors.initials: LS
authors.lastname: Fetterman
authors.forename: J
authors.initials: J
authors.lastname: Gammie
authors.forename: S
authors.initials: S
authors.lastname: Bartley
authors.forename: S R
authors.initials: SR
authors.lastname: Sutherland
authors.forename: C M
authors.initials: CM
authors.lastname: Bowers
authors.forename: R J
authors.initials: RJ
authors.lastname: Keenan
authors.forename: P F
authors.initials: PF
authors.lastname: Ferson
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001707:Biopsy, Needle / Q000009:adverse effects; D005069:Evaluation Studies as Topic; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D020708:Thoracoscopes; D013906:Thoracoscopy / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D014741:Video Recording