Small pulmonary lesions detected at CT: clinical importance.
OBJECTIVE
To evaluate the histopathologic findings of pulmonary nodules 1 cm or smaller detected at computed tomography (CT) that were removed at video-assisted thorascopic surgery.


METHODS
Clinical, radiologic, and histopathologic findings were retrospectively reviewed in 64 patients (48 women, 16 men; aged 22-85 years) who underwent video-assisted thorascopic surgical resection of small pulmonary lesions present on CT scans.


RESULTS
Sixty-four patients had a total of 65 lesions resected. Of the 64 patients, 37 (58%) patients had no known previous malignancy and 27 (42%) had previous malignancy. Overall, 58% (38 of 65 [95% confidence interval = 0.45, 0.73]) of these lesions were malignant. Among the patients without previous malignancy, 14 (38%) had lung carcinoma (10 [27%], primary bronchogenic carcinoma; four [11%], carcinoid). In patients with a previous malignancy, malignant lesions were diagnosed in 81% (22 of 27). This included seven (26%) patients with bronchogenic carcinoma as a second primary carcinoma. In patients without previous malignancy, benign lesions were diagnosed in 59% (22 of 37); in patients with previous malignancy, benign lesions were diagnosed in 18% (five of 27).


CONCLUSIONS
A considerable number of the malignant lesions were primary bronchogenic carcinoma. In addition, diagnosis in patients with a previous malignancy other than suspected metastatic disease can substantially alter treatment. For these reasons, early biopsy with an acceptable technique for diagnosis of these lesions is recommended.
Munden
R F
RF
Department of Radiology, Brigham and Women's Hospital, Boston, Mass, USA.
Pugatch
R D
RD
Liptay
M J
MJ
Sugarbaker
D J
DJ
Le
L U
LU
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D004724:Endoscopy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed