title: Incidentally Small Pulmonary Nodule in Candidates for Living Donor Liver Transplantation.
abstract: BACKGROUND
  The methods of differentiation and management of incidental small pulmonary nodules (ISN) in candidates for living donor liver transplantation (LDLT) are not well clarified. We aimed to share our experience and investigate the role of nodular size in application of ISN.
  
  
  METHODS
  From October 2009 to December 2012, 360 primary adult LDLTs were performed. Thirty-seven candidates with ISN and follow-up of over 2 years were collected. Subjects with pathologic reports of malignancy or infection composed group A, and those with pathologic reports of benign disease or stable lesions on CT image within 3~6 months composed group B.
  
  
  RESULTS
  Nodular size was significantly different between group A and B (7.68±3.77 mm versus 4.10±1.37 mm, respectively, p<0.001). Receiver-operating characteristic analysis showed area under the cure values (0.839 (95% confidence interval, 0.701~0.977); sensitivity, 81.3%; and specificity, 76.2%). Recurrent infection was not seen in 13 candidates with infectious ISN up to the median post-transplant follow-up of 40.70 months (range=24.4-61.7 months). Excluding 3 malignancy, 100% of the 34 candidates survived for over 2 years.
  
  
  CONCLUSIONS
  With 5 mm as the optimal cutoff, nodular size is a good predictor to differentiate malignant and infectious from benign ISN. For sizes less than 5 mm, follow-up of 3 months is recommended. For over 5 mm of ISN, it is recommended to obtain pathologic diagnosis and treat as diagnosis of infectious ISN.
authors.affiliation: Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yi-Ju
authors.initials: YJ
authors.lastname: Wu
authors.affiliation: Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chih-Che
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yu-Hung
authors.initials: YH
authors.lastname: Lin
authors.affiliation: Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Shih-Ho
authors.initials: SH
authors.lastname: Wang
authors.affiliation: Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Ting-Lung
authors.initials: TL
authors.lastname: Lin
authors.affiliation: Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
authors.affiliation: Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Allan M
authors.initials: AM
authors.lastname: Concejero
authors.affiliation: Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yu-Ming
authors.initials: YM
authors.lastname: Chang
authors.affiliation: Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Hung-I
authors.initials: HI
authors.lastname: Lu
authors.affiliation: Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chao-Chien
authors.initials: CC
authors.lastname: Wu
mesh_terms: D000368:Aged; D019540:Area Under Curve; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D033162:Incidental Findings; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D013624:Taiwan; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D009927:Tissue and Organ Procurement / Q000379:methods* / Q000639:trends; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome