MANAGEMENT OF SOLITARY PULMONARY NODULES - HOW TO DECIDE WHEN RESECTION IS REQUIRED

Although each case must be considered individually, there are several basic principles of management in cases of solitary pulmonary nodules: Every nodule must be regarded as potentially malignant until proven o therwise. Malignant nodules should be resected unless the procedure is contraindicated because of an unacceptably high surgical risk or evid ence of metastasis. Resection of a benign nodule rarely benefits the p atient and carries a small but significant mortality risk. Ruling out malignancy by less-invasive means than thoracotomy is desirable wherev er possible. A management decision should be reached with reasonable p romptness once a solitary pulmonary nodule has been detected. Under ce rtain circumstances, a decision to observe the nodule for a period of time with serial chest films may be appropriate, but this must be a co nsidered approach and not a ''default'' position.