title: Thoracic operations for pulmonary nodules are frequently not futile in patients with benign disease.
abstract: BACKGROUND
  Pulmonary nodules often require operative resection to obtain a diagnosis. However, 10 to 30% of operations result in a benign diagnosis. Our purpose was to determine whether negative thoracic operations are futile by describing the pathological diagnoses; determining new diagnoses and treatment changes initiated based on operative findings; and assessing morbidity, mortality, and cost of the procedure.
  
  
  METHODS
  At our academic medical center, 278 thoracic operations were performed for known or suspected cancer between January 1, 2005, and April 1, 2009. We collected and summarized data pertaining to preoperative patient and nodule characteristics, pathologic diagnosis, postoperative treatment changes resulting from surgical resection, perioperative morbidity and mortality, and hospital charges for patients with benign pathology.
  
  
  RESULTS
  Twenty-three percent (65/278) of patients who underwent surgical resection for a suspicious nodule had benign pathology. We report granulomatous disease in 57%, benign tumors in 15%, fibrosis in 12%, and autoimmune and vascular diseases in 9%. Definitive diagnosis or treatment changes occurred in 85% of cases. Surgical intervention led to a new diagnosis in 69%, treatment course changes in 68% of benign cases, medication changes in 38%, new consultation in 31%, definitive treatment in 9%, and underlying disease management in 34%. There was no intraoperative, in-hospital, or 30-day mortality. Postoperative in-hospital events occurred in seven patients. The mean total cost was $25,515 with a mean cost per day of $7618.
  
  
  CONCLUSIONS
  Patients with a benign diagnosis after surgical resection for a pulmonary nodule received a new diagnosis or had a treatment course change in 85% of the cases.
authors.affiliation: Department of Thoracic Surgery, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA. eric.grogan@vanderbilt.edu
authors.forename: Eric L
authors.initials: EL
authors.lastname: Grogan
authors.forename: Jodi J
authors.initials: JJ
authors.lastname: Weinstein
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Deppen
authors.forename: Joe B
authors.initials: JB
authors.lastname: Putnam
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Nesbitt
authors.forename: Eric S
authors.initials: ES
authors.lastname: Lambright
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Walker
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
authors.forename: Pierre P
authors.initials: PP
authors.lastname: Massion
mesh_terms: D000230:Adenocarcinoma / Q000191:economics / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted