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Video-Assisted Thoracoscopy as a Primary Modality Is Safe, Efficient, and 100% Accurate in the Diagnosis of Solitary Pulmonary Nodules

St Luke’s Roosevelt Hospital, Columbia University, College of Physicians & Surgeons, New York, NY

PURPOSE: To investigate the contribution of video-assisted thoracoscpoic surgery (VATS) as part of an aggressive approach to the diagnosis and treatment of patients presenting with solitary pulmonary nodules (SPNs).

METHODS: A retrospective chart review was performed to evaluate the outcome of solitary pulmonary nodules recommended for VATS from January 2002 through January 2003. A SPN was defined as a lung parenchymal lesion measuring 3 cm or less and no tissue diagnosis prior to surgery. Standard VATS techniques were used under general anesthesia. A wedge resection was performed, yiedling a frozen section, the pathology of which determined proceeding to lobectomy vs termination of the procedure in cases of benign nodules or advanced disease.

RESULTS: 52 patients with a diagnosis of a solitary pulmonary nodule were recommended for VATS. 35 malignancies were diagnosed, constituting a 67 percent yeild of malignancy for SPNs. Two conversions were necessary due to nodule size and location in one patient and an inability to perform single-lung ventilation in the second patient. One complication, stable atrial fibrillation, occurred on post-operative day one in a patient who underwent VATS only. The most common benign lesion was a granuloma, which in 5 of 7 patients PET scanning was positive.

CONCLUSIONS: VATS is a safe procedure, with a 100% diagnostic yield. When there is a high clinical suspicion based on a patient’s medical history, tobacco use, current medical condition and PET scan results, VATS biopsy yields a high rate of malignancy.

CLINICAL IMPLICATIONS: VATS is an integral part of the armamentarium for definitive diagnosis and treatment of lung nodules. It allows early intervention in the SPN, which in our experience is often a malignancy. Further investigation of the confounding value of PET scanning in the subset of patients with granulomatous disease is warranted.

Number of Cases Nodule Size(mm) PET Scan + PET Scan - VATS only 21 13 9 0 Benign 15 13 7 0 Malignant 6 16 2 0 VATS + lobectomy 31 19 15 4 Benign 2 18 0 1 Malignant 29 19 15 3

DISCLOSURE: L.T. Withers, None.