The evaluation of preoperative diagnostic approach to solitary pulmonary nodule with solid structure [Solid yapıdaki soliter pulmoner nodüle preoperatif tanısal yaklaşımın değerlendirilmesi]

Aim: Management of patients with solitary pulmonary nodules (SPN) after a thorough radiological evaluation may differ among different health centers. In this study in a set of radiologically solid SPN cases we aimed to compare the patients undergone surgical excision without histopathological evaluation with the patients undergone histopathological evaluation for decision of surgery. Material and Method: The patients diagnosed to have SPN between July 2009 and 2010 were retrospectively evaluated. Results: Among 42 patients enrolled in the study, 13 (%31) undergone diagnostic and therapeutic surgery (group 1), 29 (%69) undergone additional diagnostic procedures like bronchoscopy, transthoracic fine needle aspiration biopsy (TTFNAB), positron emission tomography (PET) or follow up computed tomography before decision of surgery. Malignant disease was detected in 29 cases (%69); 12 cases (%92) in group 1, and 17 (%58) cases in group 2 (p=0,035). In group 2, 11 patients (%37) were diagnosed or suspected to have malignant disease preoperatively and had proven malignancy by surgery. Out of 18 patients whose histopathological biopsy evaluation were nondiagnostic or benign, 6 (%33) had diagnosis of malignant disease after surgery, 11 patients (%61) were diagnosed to have benign disease by surgery of follow up, and 1 patient was lost in follow up. 33 patients (%79) undergone surgery among all SPN patients, 4 cases refused to have surgery although preoperative malignancy was detected or were inoperable due to comorbidities. 4 patients were thought to have benign disease in follow up period. All patients in both groups were hospitalized for diagnosis and treatment, except one patient in group 2. Medium hospitalization time was 11,76±4.22 days in group 1 and 17±12.21 in group 2 (p=0,09). Discussion: In patients that have radiologically solid SPN and that are thought to have malignant disease with preoperative radiological evaluation, additional diagnostic procedures and biopsies have limited diagnostic value and lengthens hospitalization times. In 1/3 of cases who undergone additional diagnostic procedures after detection of SPN, his-topathological diagnosis was false negative or insufficient. © 2015, Journal of Clinical and Analytical Medicine. All rights reserved