THORACOSCOPY FOR THE DIAGNOSIS OF THE INDETERMINATE SOLITARY PULMONARY NODULE

Traditional nonoperative diagnostic approaches to the indeterminate so litary pulmonary nodule include bronchoscopy and percutaneous needle b iopsy. Although both methods are minimally invasive, the diagnosis of the small, peripheral nodule may remain elusive. Open thoracotomy is o ften required when these methods fail to obtain a diagnosis. Between J anuary 1991 and June 1992, 242 patients with indeterminate solitary lu ng nodules underwent -thoracoscopic excisional biopsy as the primary d iagnostic method. Wedge excisions of the nodules were all performed by thoracoscopic techniques using an endoscopic stapler alone (72%), neo dymium:yttrium-aluminum garnet laser (18%), or both (10%). A definite diagnosis was obtained in all patients. Two patients required conversi on to thoracotomy to locate the nodule (both malignant). A benign diag nosis was obtained in 127 patients (52%) and a malignant diagnosis in 115 (48%). Of the malignant nodules, 51 (44%) were primary lung cancer and 64 (56%) were metastases. All patients diagnosed with primary lun g cancer having adequate pulmonary reserve (n = 29) underwent formal o pen lung resection during the same procedure. There was no mortality, and significant morbidity was limited to atelectasis in 3 patients (1. 2%), pneumonia in 2 patients (0.8%), and prolonged air leak more than 7 days in 4 patients (1.6%). Average hospital stay for patients having thoracoscopy only (n = 213) was 2.4 days (range, 1 to 12 days). Thora coscopy offers a minimally invasive approach for the diagnosis of the indeterminate solitary nodule. It has advantages over traditional diag nostic methods of being virtually 100% sensitive and 100% specific wit h no mortality and minimal morbidity. Based on these results, as well as the benefits of cost and time effectiveness, we anticipate a larger role for thoracoscopy in the diagnostic management of the indetermina te solitary pulmonary nodule.