title: [Surgical Treatment of Small Pulmonary Nodules Under Video-assisted Thoracoscopy  (A Report of 129 Cases)].
abstract: BACKGROUND
  The development of image technology has led to increasing detection of pulmonary small nodules year by year, but the determination of their nature before operation is difficult. This clinical study aimed to investigate the necessity and feasibility of surgical resection of pulmonary small nodules through a minimally invasive approach and the operational manner of non-small cell lung cancer (NSCLC).
  
  
  METHODS
  The clinical data of 129 cases with pulmonary small nodule of 10 mm or less in diameter were retrospectively analyzed in our hospital from December 2013 to November 2016. Thin-section computed tomography (CT) was performed on all cases with 129 pulmonary small nodules. CT-guided hook-wire precise localization was performed on 21 cases. Lobectomy, wedge resection, and segmentectomy with lymph node dissection might be performed in patients according to physical condition.
  
  
  RESULTS
  Results of the pathological examination of 37 solid pulmonary nodules (SPNs) revealed 3 primary squamous cell lung cancers, 3 invasive adenocarcinomas (IAs), 2 metastatic cancers, 2 small cell lung cancers (SCLCs), 16 hamartomas, and 12 nonspecific chronic inflammations. The results of pathological examination of 49 mixed ground glass opacities revealed 19 IAs, 6 micro invasive adenocarcinomas (MIAs), 4 adenocarcinomas in situ (AIS), 1 atypical adenomatous hyperplasia (AAH), 1 SCLC, and 18 nonspecific chronic inflammations. The results of pathological examination of 43 pure ground glass opacities revealed 19 AIS, 6 MIAs, 6 IA, 6 AAHs, and 6 nonspecific chronic inflammations. Wedge resection under video-assisted thoracoscopic surgery (VATS) was performed in patients with 52 benign pulmonary small nodules. Lobectomy and systematic lymph node dissection under VATS were performed in 33 patients with NSCLC. Segmentectomy with selective lymph node dissection, wedge resection, and selective lymph node dissection under VATS were performed in six patients with NSCLC. Two patients received secondary lobectomy and systematic lymph node dissection under VATS because of intraoperative frozen pathologic error that happened in six cases. Two cases of N2 lymph node metastasis were found in patients with SPN of IA.
  
  
  CONCLUSIONS
  Positive surgical treatment should be taken on patients with persistent pulmonary small nodules, especially ground glass opacity, because they have a high rate of malignant lesions. During the perioperative period, surgeons should fully inform the patients and family members that error exist in frozen pathologic results to avoid medical disputes.
authors.affiliation: Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Tong
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Tiansheng
authors.initials: T
authors.lastname: Yan
authors.affiliation: Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Wan
authors.affiliation: Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Shaohua
authors.initials: S
authors.lastname: Ma
authors.affiliation: Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Keyi
authors.initials: K
authors.lastname: Wang
authors.affiliation: Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Jingdi
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Jintao
authors.initials: J
authors.lastname: Song
authors.affiliation: Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Wei
authors.initials: W
authors.lastname: He
authors.affiliation: Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Bai
authors.affiliation: Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Jin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult