[Usefulness of video-assisted thoracoscopy for the diagnosis of solitary pulmonary nodules].
OBJECTIVE
Various approaches are used for the diagnosis and treatment of solitary pulmonary nodules (SPN) of unknown origin. New imaging techniques and nuclear medicine have provided more information about SPN, but surgical removal is still the most sensitive and specific way to obtain a correct analysis of the lesion. With video-assisted thoracic surgery (VATS), a histological diagnosis can be obtained without resorting to thoracotomy. In the present study we describe our experience with the diagnosis and treatment of SPN using VATS.


METHODS
From July 1992 through April 2001, 182 patients were operated on for SPN in our department.


METHODS
Retrospective study. Mean age: 59.2 years (12-78). Sex: 39 women and 143 men. Localization: Visual or instrumental exploration in 102 patients, with palpation in 52 cases and using a hookwire guided by preoperative computed tomography in 25 (with failure in 4 of those cases). Tissue was biopsied during surgery and when the lesion was malignant, oncological excision was performed during the same operation.


RESULTS
A firm diagnosis was obtained by VATS for 178 patients (98.3%). For three other patients the surgeon had to take a needle biopsy (Tru-cut) during surgery, and in one case conversion to open surgery was necessary. Histopathology: hamartoma: 11; fibrous nodule: 10; bronchiolitis obliterans: 1; pneumoconiosis: 1; mesenchymal tumor: 3; inflammatory pseudotumor: 14; mucormycosis: 1; tuberculoma:17; lymphoma: 1; carcinoid tumor: 6; metastasis: 22; bronchogenic carcinoma: 95. Mortality was 0.55%, with 1 patient dying from massive pulmonary thromboembolism. Morbidity was 5%, from 9 minor complications.


CONCLUSIONS
VATS is an effective approach, with low morbidity and mortality. We consider it to be the technique of choice for the diagnosis of all SPN and for the treatment of some, such as benign nodules and solitary metastases.
Congregado Loscertales
M
M
Servicio de Cirugía General y Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain. jloscert@us.es
Girón Arjona
J C
JC
Jiménez Merchán
R
R
Arroyo Tristán
A
A
Arenas Linares
C
C
Ayarra Jarne
J
J
Loscertales
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000295:instrumentation / Q000379:methods; D001707:Biopsy, Needle; D002277:Carcinoma / Q000175:diagnosis / Q000453:epidemiology / Q000556:secondary / Q000601:surgery; D002648:Child; D005260:Female; D005629:Frozen Sections; D006222:Hamartoma / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D013030:Spain / Q000453:epidemiology; D020775:Thoracic Surgery, Video-Assisted / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods