title: Surgical resection of highly suspicious pulmonary nodules without a tissue diagnosis.
abstract: OBJECTIVE
  The safety and efficacy of surgical resection of lung nodule without tissue diagnosis is controversial. We evaluated direct surgical resection of highly suspicious pulmonary nodules and the clinical and radiological predictors of malignancy.
  
  
  METHODS
  Retrospective analyses were performed on 113 patients who underwent surgical resection without prior tissue diagnosis for highly suspicious pulmonary nodules. Clinical and radiological characteristics were compared between histologically proven benign and malignant nodules after resection. Total costs, length of hospitalization and waiting time to surgery were compared with those of patients who had tissue diagnosis prior to surgery.
  
  
  RESULTS
  Among 280 patients with pulmonary nodules suspicious for lung cancer, 113 (40.4%) underwent operation without prior tissue diagnosis. Lung nodules were diagnosed as malignant in 96 (85%) of the 113 patients. Except for forced expiratory volume in 1 s, clinical characteristics were not significantly different according to the pathologic results. Forty-five (90%) of 50 patients with ground-glass opacity nodules had a malignancy. Mixed ground-glass opacity, bubble lucency, irregular margin and larger size correlated with malignancy in ground-glass opacity nodules (P<0.05). Fifty-one (81%) of 67 patients with solid nodules had a malignancy. Spiculation, pre-contrast attenuation and contrast enhancement significantly correlated with malignancy in solid nodules (P<0.05). Surgical resection without tissue diagnosis significantly decreased total costs, hospital stay and waiting time (P<0.05).
  
  
  CONCLUSIONS
  Direct surgical resection of highly suspicious pulmonary nodules can be a valid procedure. However, careful patient selection and further investigations are required to justify direct surgical resection.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Heo
authors.forename: Kyung Won
authors.initials: KW
authors.lastname: Lee
authors.forename: Sanghoon
authors.initials: S
authors.lastname: Jheon
authors.forename: Jae-Ho
authors.initials: JH
authors.lastname: Lee
authors.forename: Choon-Taek
authors.initials: CT
authors.lastname: Lee
authors.forename: Ho Il
authors.initials: HI
authors.lastname: Yoon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005260:Female; D005541:Forced Expiratory Volume; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000191:economics / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011013:Pneumonectomy; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D014057:Tomography, X-Ray Computed