TEMPORAL TRENDS IN THE PREVALENCE OF MALIGNANCY IN RESECTED SOLITARY PULMONARY-LESIONS

Study objective: To determine whether there has been an increase in th e prevalence of malignancy among resected, indeterminate solitary pulm onary lesions (SPL) over the past 14 years. Design: A retrospective re view of all thoracotomies for indeterminate SPLs from 1981 through 199 4. Setting: A university-affiliated VA Medical Center. Patients: Three -hundred seventy resected indeterminate SPLs (all less than or equal t o 6 cm) in 360 patients. Measurements and results: Virtually all patie nts were men with an average age of 63+/-9 years, The average lesion s ize was 2.5+/-1.4 cm; 71% were 3 cm or less, Overall, 79% of resected lesions were malignant; 94% of these were bronchogenic carcinomas, Gra nulomas accounted for more than 50% of benign lesions, The proportion of malignant diagnoses increased from 55 to 60% in 1981 to 1983 to 90 to 100% in 1990 to 1994 (p<0.005), The increasing proportion of malign ancy over time was independent of age at time of operation and lesion size, There was no significant difference in survival among patients w ith a malignant lesion resected in 1981 to 1983 compared with 1990 to 1994. Conclusion: We conclude that there has been a striking increase in the prevalence of malignancy among resected indeterminate SPLs over the past 14 years in our institution, We suspect that this trend refl ects improvements in our ability to diagnose benign SPLs preoperativel y, primarily through the use of CT, Our results should prompt other in stitutions to review their recent experience with the diagnosis of ind eterminate SPLs to provide more timely information to physicians and t heir patients who are contemplating resection of SPLs.