Differentiating early malignant lung tumors from inflammatory nodules to minimize the use of video-assisted thoracoscopic surgery or open biopsy to establish a diagnosis.
To decrease the frequency of video-assisted thoracoscopic surgery (VATS) biopsy being used to diagnose inflammatory nodules, we studied the clinicopathological findings of lung cancers and inflammatory nodules diagnosed by VATS or open-lung biopsy. We studied 46 lung cancers and 47 inflammatory nodules smaller than 30mm in diameter diagnosed by VATS or open-lung biopsy. While the computed tomography (CT) findings were not significantly different between lung cancers and inflammatory nodules, N1 or N2 lung cancers more frequently showed distinct malignant features on CT than T1N0M0 lung cancers (P < 0.05). A review of previous chest X-ray films revealed that those of inflammatory nodules showed new nodules more frequently and nodular enlargement less frequently than those of lung cancer (P < 0.01). Of 13 lung cancers that showed nodular enlargement during a mean 15-month period, 12 were T1N0M0. Nondiagnosable small lung nodules, which had few malignant features on CT and had newly appeared on a chest X-ray film, were more likely to be inflammatory nodules than lung cancers; and even if they were lung cancers, the tumor stage was usually T1N0M0. Thus, to decrease the incidence of VATS biopsy being performed for inflammatory nodules, intensive follow-up by CT until slight nodular enlargement becomes evident could be a means of revealing nondiagnosable small lung nodules without distinct malignant findings, except for nodules found to be enlarging on a review of retrospective films.
Nomori
H
H
Department of Thoracic Surgery, Saiseikai Central Hospital, Tokyo, Japan.
Horio
H
H
Suemasu
K
K
D000328:Adult; D001706:Biopsy; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D018450:Disease Progression; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007249:Inflammation; D008171:Lung Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D020775:Thoracic Surgery, Video-Assisted; D014057:Tomography, X-Ray Computed