Incidental lung carcinoma detected at CT in patients selected for lung volume reduction surgery to treat severe pulmonary emphysema.
OBJECTIVE
The authors present their experience with previously unsuspected carcinoma of the lung detected at preoperative computed tomography (CT) in patients with severe pulmonary emphysema who were scheduled to undergo lung volume reduction surgery.


METHODS
Preoperative chest CT was performed in 148 patients (84 men, 64 women; mean age, 65 years +/- 8 [standard deviation]) with advanced pulmonary emphysema before lung volume reduction surgery. At surgery, an attempt was made to excise any pulmonary nodule considered suspicious for carcinoma at CT.


RESULTS
Eighteen pulmonary nodules suspicious for lung cancer were found at CT in 17 (11%) of the 148 patients. Sixteen of these 148 nodules were resected at lung volume reduction surgery. Nine non-small cell carcinomas (adenocarcinoma, n = 4, including three with bronchioloalveolar differentiation; poorly differentiated, n = 3; squamous cell carcinoma, n = 2) were found in eight (5%) patients. Eight of the cancers were stage I, and one was unstaged surgically. Maximum diameters of the cancers ranged between 1.0 and 3.8 cm (median, 1.6 cm). The seven (5%) other resected nodules were all benign.


CONCLUSIONS
A 5% rate of stage I primary lung cancer in patients selected for lung volume reduction surgery suggests that performance of chest CT in candidates for lung volume reduction surgery is appropriate not only to identify patterns of pulmonary parenchymal destruction but also to search for stage I lung cancer.
Rozenshtein
A
A
Department of Radiology, Columbia-Presbyterian Medical Center, New York, NY, USA.
White
C S
CS
Austin
J H
JH
Romney
B M
BM
Protopapas
Z
Z
Krasna
M J
MJ
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000601:surgery; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000000981:diagnostic imaging / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006099:Granuloma / Q000000981:diagnostic imaging / Q000601:surgery; D006222:Hamartoma / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011014:Pneumonia / Q000000981:diagnostic imaging / Q000601:surgery; D011300:Preoperative Care; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000601:surgery*; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging / Q000601:surgery; D013902:Radiography, Thoracic; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed