Diagnosis of solitary pulmonary nodule: optimal strategy based on nodal size.
We attempted to determine the smallest size of nodule that could be accurately diagnosed by fluoroscopic fiberoptic bronchoscopy (FFB) and computed tomography (CT) guided trans-corporeal biopsy (CTGB) procedures. Parenchymal lesions (n=1483) detected using chest roentgenography were investigated in the present study, and the diagnostic capabilities of FFB and CTGB were determined based on receiver-operating characteristic curves. A total of 990 nodules (67%) were diagnosed using FFB, while 58 (4%) were diagnosed with CTGB, 339 (23%) by surgery, and 100 (6%) by other methods. The area under the curve (AUC) was 0.74 (0.72<95% CI <0.77) in FFB cases and 0.95 (0.92<95% CI <0.98) in CTGB cases. FFB was found capable of diagnosing nodules with sizes between 0 and 1.0 cm, 1.0 and 1.5 cm, 1.5 and 2.0 cm, and more than 2.0 cm at ratios of 0/58 (0%), 19/115 (16%), 59/141 (35%), and 1072/1173 (97%), respectively (P<0.0001). The diagnostic ability of CTGB for nodules categorized in the same manner was 0/25 (0%), 2/29 (7%), 5/24 (21%), and 53/63 (84%), respectively (P<0.0001). For SPNs smaller than 1.5 cm in diameter, both FFB and CTGB showed a low diagnostic sensitivity.
Department of Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City, Osaka 565-0871, Japan. sawabata@surg1.med.osaka-u.ac.jp
Noriyoshi
N
Sawabata
Soichiro
S
Yokota
Hajime
H
Maeda
Masaru
M
Nakagawa
Toshihiko
T
Yamaguchi
Tatsuya
T
Okada
Masami
M
Itho