title: Therapeutic surgery without a definitive diagnosis can be an option in selected patients with suspected lung cancer.
abstract: OBJECTIVE
  With the recent improvements in the diagnostic accuracy of radiographic modalities, it might be an option to perform therapeutic surgery without a definitive diagnosis for selected patients with suspected lung cancer based on the findings of diagnostic imaging.
  
  
  METHODS
  Between April 2008 and December 2012, all nodules without a definitive diagnosis were classified into five categories according to the probability of lung cancer based on the diagnostic imaging: Category 1 (Benign), Category 2 (Probably benign), Category 3 (Intermediate), Category 4 (Suspected malignancy) and Category 5 (Highly suggestive of malignancy). In this study, the 232 surgical candidates for suspected clinical stage I lung cancer without a preoperative definitive diagnosis were considered to be Category 3 (n = 29), Category 4 (n = 46) and Category 5 (n = 157). Eighty-two patients (72% of Category 3, 46% of Category 4 and 25% of Category 5) had an intraoperative diagnosis during surgery, whereas the remaining 150 patients did not. The final pathological diagnosis and surgical outcomes were analysed.
  
  
  RESULTS
  The final pathological diagnosis of the 232 suspicious nodules revealed 214 lung cancers (52% of Category 3, 93% of Category 4 and 99% of Category 5). Wedge resection was performed for all seven benign tumours. In the multiple regression analysis, intraoperative diagnosis was a significant factor for the length of the operation. In the multivariate logistic regression analysis, the length of the operation was a significant factor predicting both the postoperative morbidity and a prolonged hospital stay.
  
  
  CONCLUSIONS
  Based on a careful clinical decision made using the current diagnostic imaging strategies, patients with a high probability of lung cancer are good candidates for therapeutic surgery, even without a preoperative or intraoperative definitive diagnosis.
authors.affiliation: Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Ozeki
authors.affiliation: Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Iwano
authors.affiliation: Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Taniguchi
authors.affiliation: Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kawaguchi
authors.affiliation: Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Fukui
authors.affiliation: Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Futoshi
authors.initials: F
authors.lastname: Ishiguro
authors.affiliation: Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Fukumoto
authors.affiliation: Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Shota
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Biostatistics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hirakawa
authors.affiliation: Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan k-yokoi@med.nagoya-u.ac.jp.
authors.forename: Kohei
authors.initials: K
authors.lastname: Yokoi
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008175:Lung Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D018579:Patient Selection; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Diagnosis; Frozen section; Lung cancer; Surgery