SMALL PULMONARY-LESIONS DETECTED AT CT - CLINICAL IMPORTANCE

PURPOSE: To evaluate the histopathologic findings of pulmonary nodules 1 cm or smaller detected at computed tomography (CT) that were remove d at video-assisted thorascopic surgery. MATERIALS AND METHODS: Clinic al, radiologic, and histopathologic findings were retrospectively revi ewed in 64 patients (48 women, 16 men; aged 22-85 years) who underwent video-assisted thorascopic surgical resection of small pulmonary lesi ons present on CT scans. RESULTS: Sixty-four patients had a total of 6 5 lesions resected. Of the 64 patients, 37 (58%) patients had no known previous malignancy and 27 (42%) had previous malignancy. Overall, 58 % (38 of 65 [95% confidence interval = 0.45, 0.73]) of these lesions w ere malignant. Among the patients without previous malignancy, 14 (38% ) had lung carcinoma (10 [27%], primary bronchogenic carcinoma; four [ 11%], carcinoid). In patients with a previous malignancy, malignant le sions were diagnosed in 81% (22 of 27). This included seven (26%) pati ents with bronchogenic carcinoma as a second primary carcinoma. In pat ients without previous malignancy, benign lesions were diagnosed in 59 % (22 of 37); in patients with previous malignancy, benign lesions wer e diagnosed in 18% (five of 27). CONCLUSION: A considerable number of the malignant lesions were primary bronchogenic carcinoma. In addition , diagnosis in patients with a previous malignancy other than suspecte d metastatic disease can substantially alter treatment. For these reas ons, early biopsy with an acceptable technique for diagnosis of these lesions is recommended.