DIAGNOSING THE INDETERMINATE PULMONARY NODULE - PERCUTANEOUS BIOPSY VERSUS THORACOSCOPY

Background. The malignant potential of indeterminate solitary pulmonary nodules (SPN) mandates accurate diagnostic management. Methods. 613 patients undergoing either computed tomographic lung biopsy (CT-Ex) (n = 312) or thoracoscopic excisional biopsy (Thor-Bx) (n = 301) for the diagnosis of SPN were evaluated for relative accuracy, complications, and effect on clinical treatment. Results. CT-Ex identified a malignant diagnosis (Dx) in 201 (64%) of 312 patients; 85 (42%) underwent operations. A total of 116 patients (58%) with synchronous cancer (n = 16), impaired physiologic condition, or unresectable lesions (n = 100) were not operated. Surgical treatment was deferred for 20 patients (6%) with a ''specific benign'' Dx and 44 physiologically impaired patients with ''nonspecific benign'' CT-Ex. Forty-seven patients with ''nonspecific benign'' Dx underwent operation. Thirty-two (68%) lesions were malignant (4 metastatic, 28 primary cancer). CT-Bx accuracy was 86% for malignant and 79 (71%) of 111) for benign lesions. Surgery was still required for 132 (82%) of 163 patients with resectable lesions. Complications occurred in 24% of patients. A specific benign or malignant Dr was obtained in 292 (96%) of 301 patients undergoing Thor-Bx. Conversion to thoracotomy for lobectomy occurred in 38 (21%) of 179 patients with lung cancer One hundred forty-one patients with lung cancer and impaired physiologic condition and all patients with metastatic (n = 44) and benign lesions (n = 78) had thoracoscopic resection alone Complications occurred in 22% of patients. Conclusions. Limited accuracy for benign Dr with CT-Ex requires surgical biopsy for patients with SPN with adequate physiologic reserve. Thor-Bx is a safe and accurate minimally invasive surgical approach to resectable peripheral SPN.