Character of Solitary Pulmonary Nodules:Analysis of Risk Factors and Surgical Treatment_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANGBin , SUNTian-yu , DENGBo , GUOWei , ZHOUJing-hai , WANGRu-wen ,  TANQun-you

Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, P. R. China;

Corresponding?author：

TANQun-you, Email: tanfriends@163.com

Keywords：

Solitary pulmonary nodule; Video-assisted thoracoscopic surgery (VATS); Lung cancer; Diagnosis; Treatment

DOI：

10.7507/1007-4848.20160168

Video：

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Objective To summarize the experience of diagnosis and surgical treatment for solitary pulmonary nodules (SPN). Methods We retrospectively analyzed clinical data of 327 patients with video-assisted thoracoscopic surgery (VATS) lung resections and subsequent pathological diagnosis of the SPNs in Daping Hospital from January 2008 through May 2014 year. There were 183 males, 144 females at age of 56.6(20-79) years. Results One way analysis of variance showed that there were significant differences in age, smoking index, diameter, glitches, lobulation, traction of pleural, cavity, vascular convergence, calcification between benign and malignant lesions (P<0.05). Logistic regression analysis revealed that age (P=0.004, OR=1.084), diameter (P<0.001, OR=1.467), glitches (P=0.001, OR=8.754), lobulation (P<0.001, OR=10.424), traction of pleural (P=0.002, OR=6.619) were independent predictors of malignancy in patients with SPN. Operation time was 121.4±47.6 min. Blood loss was 105.3±57.8 ml. Postoperative hospital stay was 7.3±2.4 days. Diagnostic accuracy was 99.7%. Incidence of complication was 0.5%. Five (1.5%) patients were converted to thoracotomy and no perioperative death occurred. Conclusions Age, diameter, glitches, lobulation, traction of pleural are independent predictors of malignancy in the patients with SPN. VATS is a safe and efficient method for diagnosis and treatment of SPN.

Citation： JIANGBin, SUNTian-yu, DENGBo, GUOWei, ZHOUJing-hai, WANGRu-wen, TANQun-you. Character of Solitary Pulmonary Nodules:Analysis of Risk Factors and Surgical Treatment. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(7): 702-705. doi: 10.7507/1007-4848.20160168 Copy

1.	Ost D, Fein A. Management strategies for the solitary pulmonary nodule. Curr Opin Pulm Med, 2004, 10(4):272-278.
2.	Albert RH, Russell JJ. Evaluation of the solitary pulmonary nodule. Am Fam Physicion, 2009, 80(8):827-831.
3.	Khan AN, Al-Jahdali HH, Irion KL, et al. Solitary pulmonary nodule:A diagnostic algorithm in the light of current imaging technique. Avicenna J Med, 2011, 1(2):39-51.
4.	Gohagan J, Marcus P, Fagerstrom R, et al. Baseline findings of a randomized feasibility trial of lung cancer screening with spiral CT scan vs chest radiograph:the Lung Screening Study of the National Cancer Institute. Chest, 2004, 126(1):114-121.
5.	Swensen SJ, Jett JR, Hartman TE, et al. Lung cancer screening with CT:Mayo Clinic experience. Radiology, 2003, 226(3):756-761.
6.	Wang YX, Gong JS, Suzuki K, et al. Evidence based imaging strategies for solitary pulmonary nodule. J Thorac Dis, 2014, 6(7):872-887.
7.	蘇雷, 支修益, 張毅, 等. 胸腔鏡輔助治療孤立性肺結節120例分析. 中國微創外科雜志, 2013, (11):966-968, 973.
8.	Lillington GA, Caskey CI. Evaluation and management of solitary and multiple pulmonary nodules. Clin Chest Med, 1993, 14(1):111-119.
9.	Viggiano RW, Swensen SJ, Rosenow EC 3rd. Evaluation and management of solitary and multiple pulmonary nodules. Clin Chest Med, 1992, 13(1):83-95.
10.	Swensen SJ, Silverstein MD, Ilstrup DM, et al. The probability of malignancy in solitary pulmonary nodules. Application to small radiologically indeterminate nodules. Arch Intern Med, 1997, 157(8):849-855.
11.	Choi SM, Heo EY, Lee J, et al. Characteristics of benign solitary pulmonary nodules confirmed by diagnostic video-assisted thoracoscopic surgery. Clin Respir J, 2016, 10(2):181-188.
12.	Shi CZ, Zhao Q, Luo LP, et al. Size of solitary pulmonary nodule was the risk factor of malignancy. J Thorac Dis, 2014, 6(6):668-676.
13.	Ost D, Fein AM, Feinsilver SH. Clinical practice. The solitary pulmonary nodule. N Engl J Med, 2003, 348(25):2535-2542.
14.	Aberle DR, Brown K. Lung cancer screening with CT. Clin Chest Med, 2008, 29(1):1-14.
15.	Murrmann GB, van Vollenhoven FH, Moodley L. Approach to a solid solitary pulmonary nodule in two different settings-"Common is common, rare is rare". J Thorac Dis, 2014, 6(3):237-248.
16.	Yim AP, Wan S, Lee TW, et al. VATS lobectomy reduces cytokine responses compared with conventional surgery. Ann Thorac Surg, 2000, 70(1):243-247.
17.	Park TY, Park YS. Long-term respiratory function recovery in patients with stage I lung cancer receiving video-assisted thoracic surgery versus thoracotomy. J Thorac Dis, 2016, 8(1):161-168.
18.	王志強, 呂德勝, 岳世昌. 電視胸腔鏡手術在孤立性肺結節診治中的價值. 中國胸心血管外科臨床雜志, 2013, 20(5):607-610.
19.	張皓, 齊海, 王磊, 等. 電視胸腔鏡與開胸手術治療非小細胞肺癌隨機對照研究的系統評價和Meta分析. 中國胸心血管外科臨床雜志, 2015, 22(12):1087-1094.
20.	Nicastri DG, Wisnivesky JP, Litle VR, et al. Thoracoscopic lobectomy:report on safety, discharge independence, pain, and chemotherapy tolerance. J Thorac Cardiovasc Surg, 2008, 135(3):642-647.
21.	Yan TD, Black D, Bannon PG, et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol, 2009, 27(15):2553-2562.

1. Ost D, Fein A. Management strategies for the solitary pulmonary nodule. Curr Opin Pulm Med, 2004, 10(4):272-278.
2. Albert RH, Russell JJ. Evaluation of the solitary pulmonary nodule. Am Fam Physicion, 2009, 80(8):827-831.
3. Khan AN, Al-Jahdali HH, Irion KL, et al. Solitary pulmonary nodule:A diagnostic algorithm in the light of current imaging technique. Avicenna J Med, 2011, 1(2):39-51.
4. Gohagan J, Marcus P, Fagerstrom R, et al. Baseline findings of a randomized feasibility trial of lung cancer screening with spiral CT scan vs chest radiograph:the Lung Screening Study of the National Cancer Institute. Chest, 2004, 126(1):114-121.
5. Swensen SJ, Jett JR, Hartman TE, et al. Lung cancer screening with CT:Mayo Clinic experience. Radiology, 2003, 226(3):756-761.
6. Wang YX, Gong JS, Suzuki K, et al. Evidence based imaging strategies for solitary pulmonary nodule. J Thorac Dis, 2014, 6(7):872-887.
7. 蘇雷, 支修益, 張毅, 等. 胸腔鏡輔助治療孤立性肺結節120例分析. 中國微創外科雜志, 2013, (11):966-968, 973.
8. Lillington GA, Caskey CI. Evaluation and management of solitary and multiple pulmonary nodules. Clin Chest Med, 1993, 14(1):111-119.
9. Viggiano RW, Swensen SJ, Rosenow EC 3rd. Evaluation and management of solitary and multiple pulmonary nodules. Clin Chest Med, 1992, 13(1):83-95.
10. Swensen SJ, Silverstein MD, Ilstrup DM, et al. The probability of malignancy in solitary pulmonary nodules. Application to small radiologically indeterminate nodules. Arch Intern Med, 1997, 157(8):849-855.
11. Choi SM, Heo EY, Lee J, et al. Characteristics of benign solitary pulmonary nodules confirmed by diagnostic video-assisted thoracoscopic surgery. Clin Respir J, 2016, 10(2):181-188.
12. Shi CZ, Zhao Q, Luo LP, et al. Size of solitary pulmonary nodule was the risk factor of malignancy. J Thorac Dis, 2014, 6(6):668-676.
13. Ost D, Fein AM, Feinsilver SH. Clinical practice. The solitary pulmonary nodule. N Engl J Med, 2003, 348(25):2535-2542.
14. Aberle DR, Brown K. Lung cancer screening with CT. Clin Chest Med, 2008, 29(1):1-14.
15. Murrmann GB, van Vollenhoven FH, Moodley L. Approach to a solid solitary pulmonary nodule in two different settings-"Common is common, rare is rare". J Thorac Dis, 2014, 6(3):237-248.
16. Yim AP, Wan S, Lee TW, et al. VATS lobectomy reduces cytokine responses compared with conventional surgery. Ann Thorac Surg, 2000, 70(1):243-247.
17. Park TY, Park YS. Long-term respiratory function recovery in patients with stage I lung cancer receiving video-assisted thoracic surgery versus thoracotomy. J Thorac Dis, 2016, 8(1):161-168.
18. 王志強, 呂德勝, 岳世昌. 電視胸腔鏡手術在孤立性肺結節診治中的價值. 中國胸心血管外科臨床雜志, 2013, 20(5):607-610.
19. 張皓, 齊海, 王磊, 等. 電視胸腔鏡與開胸手術治療非小細胞肺癌隨機對照研究的系統評價和Meta分析. 中國胸心血管外科臨床雜志, 2015, 22(12):1087-1094.
20. Nicastri DG, Wisnivesky JP, Litle VR, et al. Thoracoscopic lobectomy:report on safety, discharge independence, pain, and chemotherapy tolerance. J Thorac Cardiovasc Surg, 2008, 135(3):642-647.
21. Yan TD, Black D, Bannon PG, et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol, 2009, 27(15):2553-2562.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Character of Solitary Pulmonary Nodules:Analysis of Risk Factors and Surgical Treatment

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