Is tissue still the issue? Lobectomy for suspicious lung nodules without confirmation of malignancy

Kaaki, Suha; Kidane, Biniam; Srinathan, Sadeesh; Tan, Lawrence; Buduhan, Gordon

doi:10.1002/jso.25003

Cited by 8 publications

(5 citation statements)

References 17 publications

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“…Bronchoscopic sampling has a low yield for peripheral and small nodules, whereas intraoperative frozen section analysis may be difficult for small or central nodules and it can increase surgical time and cost. Alternatively, upfront surgery has been proposed for SPNs that are highly suspicious for NSCLC based on their clinical and imaging characteristics in the absence of tissue confirmation [21][22][23]. However, there is concern associated with performing unnecessary surgery for benign lesions and subjecting patients to potential morbidity.…”

Section: Discussionmentioning

confidence: 99%

Radiomics and Artificial Intelligence Can Predict Malignancy of Solitary Pulmonary Nodules in the Elderly

et al. 2023

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Solitary pulmonary nodules (SPNs) are a diagnostic and therapeutic challenge for thoracic surgeons. Although such lesions are usually benign, the risk of malignancy remains significant, particularly in elderly patients, who represent a large segment of the affected population. Surgical treatment in this subset, which usually presents several comorbidities, requires careful evaluation, especially when pre-operative biopsy is not feasible and comorbidities may jeopardize the outcome. Radiomics and artificial intelligence (AI) are progressively being applied in predicting malignancy in suspicious nodules and assisting the decision-making process. In this study, we analyzed features of the radiomic images of 71 patients with SPN aged more than 75 years (median 79, IQR 76–81) who had undergone upfront pulmonary resection based on CT and PET-CT findings. Three different machine learning algorithms were applied—functional tree, Rep Tree and J48. Histology was malignant in 64.8% of nodules and the best predictive value was achieved by the J48 model (AUC 0.9). The use of AI analysis of radiomic features may be applied to the decision-making process in elderly frail patients with suspicious SPNs to minimize the false positive rate and reduce the incidence of unnecessary surgery.

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Section: Discussionmentioning

confidence: 99%

Radiomics and Artificial Intelligence Can Predict Malignancy of Solitary Pulmonary Nodules in the Elderly

et al. 2023

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“…The accuracy, low morbidity, and easy availability of the technique make it used procedure for small lung nodules in our hospital. Moreover, there is a study that shows that direct resection of the suspicious lung nodules without preoperative biopsy will not increase the incidence of resected benign pathology and may decrease surgical wait time (24). In this respect, it is important to predict the malignancy of the nodule without preoperative biopsy.…”

Section: The Conventional Diagnosis and Procedures Of Small Lung Nodules And Their Limitationmentioning

confidence: 99%

The multidisciplinary team plays an important role in the prediction of small solitary pulmonary nodules: a propensity-score-matching study

Liu¹,

Zhao²,

Wu³

et al. 2019

Ann Transl Med

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Background: According to guidelines, it is recommended that pulmonary nodules be discussed by a multidisciplinary team (MDT); however, the evidence for the effectiveness of MDT is sparse. To demonstrate the importance of the involvement of an MDT for the prediction of small solitary pulmonary nodules, we conducted this retrospective study. Methods:The patient database of those who attended our MDT and the electronic medical record system of our hospital was used; we collected all the data from patients found with small solitary pulmonary nodules (≤2 cm), which were suspected as malignant and who received a resection of the nodules. We summarized their characteristics and analyzed them, and then compared the post-operation pathological diagnosis of the patients who attended an MDT to those who did not participate in an MDT during the same period (2017-2019.2). We also collected the follow-up data. Propensity-score-matching was utilized during the process of analysis to get a more reliable conclusion.Results: Most of the qualified patients were female. Most of the small solitary pulmonary nodules (≤2 cm) were adenocarcinoma and located on the right upper lobe. There were no differences in the SUV value between malignant nodules and benign nodules. After propensity-score matching, the total positive prediction value of small solitary pulmonary nodules (≤2 cm) without an MDT was 69.4%, while that with MDT was 77.6%; the difference was not significant with a P value of 0.30. The negative predictive value of MDT was 76.2%. Conclusions:In developing countries, small solitary pulmonary nodules tend to be more correctly diagnosed with MDT.

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“…1). Diagnostic lobectomy or segmentectomy is commonly performed and usually does not lead to major complications [8,9]. The proportion of pulmonary nodules determined to be cancer in biopsy results varies greatly depending on their size and shape [10,11].…”

Section: Introductionmentioning

confidence: 99%

Video-Assisted Thoracic Surgery Core Needle Biopsy for Pulmonary Nodules in Patients with Impaired Lung Function: Is It Feasible and Safe?

et al. 2023

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Background:The number of patients with incidentally identified pulmonary nodules is increasing. This study attempted to confirm the usefulness and safety of video-assisted thoracic surgery (VATS) core needle biopsy of pulmonary nodules. Methods: Data from 18 patients diagnosed with pulmonary nodules who underwent VATS core need biopsy were retrospectively reviewed. Results: Of the 18 patients, 15 had malignancies (primary lung cancer, n=14; metastatic lung cancer, n=1), and 3 had benign nodules. Mortality and pleural metastasis did not occur during the follow-up period. Conclusion:In patients with solitary pulmonary nodules that require tissue confirmation, computed tomography-guided percutaneous cutting needle biopsy or diagnostic pulmonary resection sometimes may not be feasible choices due to the location of the solitary pulmonary nodule or the patient's impaired pulmonary function, VATS core needle biopsy may be performed in these patients as an alternative method.

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Is tissue still the issue? Lobectomy for suspicious lung nodules without confirmation of malignancy

Abstract: Foregoing biopsies and proceeding to lobectomy in selected patients with suspicious lung nodules is safe, did not increase the incidence of resected benign pathology, and may decrease surgical wait time. Patients should be carefully evaluated and counseled.

Cited by 8 publications

References 17 publications

Radiomics and Artificial Intelligence Can Predict Malignancy of Solitary Pulmonary Nodules in the Elderly

Radiomics and Artificial Intelligence Can Predict Malignancy of Solitary Pulmonary Nodules in the Elderly

The multidisciplinary team plays an important role in the prediction of small solitary pulmonary nodules: a propensity-score-matching study

Video-Assisted Thoracic Surgery Core Needle Biopsy for Pulmonary Nodules in Patients with Impaired Lung Function: Is It Feasible and Safe?

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