Does aggressive management of solitary pulmonary nodules pay off?
| Autor: | Georgia Hardavella, Serafina Loprete, Alessandro De Stefano, Stefano Elia |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Reviews 030218 nuclear medicine & medical imaging solitary pulmonary nodule minimally invasive surgery video-assisted thoracic surgery 03 medical and health sciences 0302 clinical medicine False positive paradox Medicine Lung cancer minimally invasive surgery lcsh:RC705-779 Surgical approach medicine.diagnostic_test business.industry Fdg uptake lcsh:Diseases of the respiratory system Delayed treatment video-assisted thoracic surgery medicine.disease Positron emission tomography Cardiothoracic surgery 030220 oncology & carcinogenesis Radiological weapon Settore MED/21 Radiology business |
| Zdroj: | Elia, S, Loprete, S, De Stefano, A & Hardavella, G 2019, ' Does aggressive management of solitary pulmonary nodules pay off? ', Breathe, vol. 15, no. 1, pp. 15-23 . https://doi.org/10.1183/20734735.0275-2018 Breathe Breathe, Vol 15, Iss 1, Pp 15-23 (2019) |
| ISSN: | 2073-4735 1810-6838 |
| Popis: | Indeterminate solitary pulmonary nodules (SPNs), measuring up to 3 cm in diameter, are incidental radiological findings. The ever-growing use of modern imaging has increased their detection. The majority of those nodules are benign; however, the possibility of diagnosing early-stage lung cancer still stands. Guidelines for the management of SPNs have never been validated in prospective comparative studies. Positron emission tomography (PET) is a useful tool to provide functional information on SPNs. However, overall sensitivity and specificity of PET in detecting malignant SPNs of at least 10 mm in diameter are about 90% and false-negative results are reported. The development of video-assisted thoracic surgery has provided minimally invasive diagnosis and treatment of SPNs. In our series, 105 patients underwent surgery based on combined increased 18F-labelled 2-fluoro-2-deoxy-d-glucose (FDG) uptake on PET computed tomography and radiological features (morphology and density) without prior histological confirmation. We detected 26 false negatives (24.8%) and only nine false positives (8.57%). Therefore, our minimally invasive surgical approach prevented 25% of patients with lung cancer from a delayed treatment versus only 9% undergoing “overtreatment”. In our monocentric cohort, patients with SPNs with large diameter, irregular outline, no calcifications, central location, increased FDG uptake and/or subsolid aspect benefited from a primary surgical resection. There is much debate on the best management of solitary pulmonary nodules. Even if they are mostly benign, they may represent an early-stage lung cancer. Minimally invasive surgical removal is probably the best approach to this insidious disease. http://ow.ly/wMKz30nemjR |
| Databáze: | OpenAIRE |
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