INCIDENTAL LUNG-CARCINOMA DETECTED AT CT IN PATIENTS SELECTED FOR LUNG-VOLUME REDUCTION SURGERY TO TREAT SEVERE PULMONARY-EMPHYSEMA

PURPOSE: The authors present their experience with previously unsuspec ted carcinoma of the lung detected at preoperative computed tomography (CT) in patients with severe pulmonary emphysema who were scheduled t o undergo lung volume reduction surgery. MATERIALS AND METHODS: Preope rative chest CT was performed in 148 patients (84 men, 64 women; mean age, 65 years +/- 8 [standard deviation]) with advanced pulmonary emph ysema before lung volume reduction surgery. At surgery, an attempt was made to excise any pulmonary nodule considered suspicious for carcino ma at CT. RESULTS: Eighteen pulmonary nodules suspicious for lung canc er were found at CT in 17 (11%) of the 148 patients. Sixteen of these 148 nodules were resected at lung volume reduction surgery. Nine non-s mall cell carcinomas (adenocarcinoma, n = 4, including three with bron chioloalveolar differentiation; poorly differentiated n = 3; squamous cell carcinoma, n = 2) were found in eight (5%) patients. Eight of the cancers were stage I, and one was unstaged surgically. Maximum diamet ers of the cancers ranged between 1.0 and 3.8 cm (median, 1.6 cm). The seven (5%) other resected nodules were all benign. CONCLUSION: A 5% r ate of stage I primary lung cancer in patients selected for lung volum e reduction surgery suggests that performance of chest CT in candidate s for lung volume reduction surgery is appropriate not only to identif y patterns of pulmonary parenchymal destruction but also to search for stage I lung cancer.