Skip to main content

Der solitäre Lungenrundherd

Bewertung und Therapie

Solitary pulmonary nodule

Assessment and therapy

Der Chirurg volume 78, pages 687–697 (2007)Cite this article

Zusammenfassung

Der solitäre Lungenrundherd ist eine runde, bis 3 cm große, radiomorphologische Veränderung, allseits von Lungengewebe umgeben. Er gilt bis zum Beweis des Gegenteils als maligne. Das periphere Lungenkarzinom ist mit ca. 40% die häufigste Ursache. Mit steigendem Alter des Patienten nimmt das Risiko auf Bösartigkeit zu. Die Spiralcomputertomographie zeigt die genaue anatomische Lage und deckt mögliche pathologische Begleitbefunde auf. Auch bösartige Rundherde können mehr als 2 Jahre an Größe konstant bleiben. Nur durch die komplette histologische Aufarbeitung kann Malignität ausgeschlossen werden. Jeder solitäre Lungenrundherd sollte deswegen, bei bestehender Operabilität des Patienten, reseziert werden. Das operative Risiko der videoassistierten Thorakoskopie und der diagnostischen Thorakotomie ist gering. Nur bei inoperablen Patienten kommen weitere diagnostische Maßnahmen, wie die transthorakale Nadelaspirationsbiopsie oder die PET/CT zur Anwendung.

Abstract

Solitary pulmonary nodules (SPN) are radiologically defined as intraparenchymal lung lesions not bigger then 3 cm. In general all pulmonary nodules should be considered malignant until proven otherwise. Primary peripheral lung cancer is the most common cause, at 40%. The probability that an SPN is malignant increases with patient age. Spiral chest CT is the ideal imaging to indicate the precise anatomical location and expose other pathological findings. Malignant SPN can also persist without change for over 2 years. Only complete histological examination can exclude malignance. Therefore every SPN should be resected in operable patients. The surgical risk of video-assisted pulmonary resection and diagnostic thoracotomy is low. For patients who are not operable, other diagnostic procedures such as transthoracic needle aspiration or positron emission tomography may be helpful.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8

Literatur

  1. American Thoracic Society, European Respiratory Society (1997) Pretreatment evaluation of non-small-cell lung cancer Am J Respir Crit Care Med 156: 320–332

    Google Scholar 

  2. Baaklini WA, Reinoso MA, Gorin AB et al. (2000) Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. Chest 117: 1049–1054

    PubMed  Article  CAS  Google Scholar 

  3. Bergmann T, Bolukbas S, Beqiri S et al. (2006) Video-assisted diagnostic thoracoscopy Chirurg 77: 998–1006

    Google Scholar 

  4. Boiselle PM, Shepard JA, Mark EJ et al. (1997) Routine addition of an automated biopsy device to fine-needle aspiration of the lung: a prospective assessment. AJR Am J Roentgenol 169: 661–666

    PubMed  CAS  Google Scholar 

  5. Brenner MW, Holsti LR, Perttala Y (1967) The study by graphical analysis of the growth of human tumours and metastases of the lung. Br J Cancer 21: 1–13

    PubMed  CAS  Google Scholar 

  6. Cahan WG, Shah JP, Castro EB (1978) Benign solitary lung lesions in patients with cancer. Ann Surg 187: 241–244

    PubMed  Article  CAS  Google Scholar 

  7. Cummings SR, Lillington GA, Richard RJ (1986) Estimating the probability of malignancy in solitary pulmonary nodules. A Bayesian approach. Am Rev Respir Dis 134: 449–452

    PubMed  CAS  Google Scholar 

  8. Detterbeck FC (ed) (2001) Diagnosis and treatment of lung cancer: An evidence-based guide for the practicing clinician. W.B. Saunders, Philadelphia

  9. Diederich S, Wormanns D, Semik M et al. (2002) Screening for early lung cancer with low-dose spiral CT: prevalence in 817 asymptomatic smokers. Radiology 222: 773–781

    PubMed  Article  Google Scholar 

  10. Edwards FH, Schaefer PS, Cohen AJ et al. (1989) Use of artificial intelligence for the preoperative diagnosis of pulmonary lesions. Ann Thorac Surg 48: 556–559

    PubMed  CAS  Article  Google Scholar 

  11. Edwards SE, Fry IK (1982) Prevalence of lung nodules on computed tomography of patients without known malignant disease. Br J Radiol 55: 715–716

    PubMed  CAS  Article  Google Scholar 

  12. Fletcher EC, Levin DC (1982) Flexible fiberoptic bronchoscopy and fluoroscopically guided transbronchial biopsy in the management of solitary pulmonary nodules. West J Med 136: 477–483

    PubMed  CAS  Google Scholar 

  13. Geddes DM (1979) The natural history of lung cancer: a review based on rates of tumour growth. Br J Dis Chest 73: 1–17

    PubMed  CAS  Article  Google Scholar 

  14. Ginsberg RJ, Rubinstein LV (1995) Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg 60: 615–622

    PubMed  Article  CAS  Google Scholar 

  15. Goldsmith SJ, Kostakoglu L (2000) Nuclear medicine imaging of lung cancer. Radiol Clin North Am 38: 511–524

    PubMed  Article  CAS  Google Scholar 

  16. Good CA, Wilson TW (1958) The solitary circumscribed pulmonary nodule; study of seven hundred five cases encountered roentgenologically in a period of three and one-half years. JAMA 166: 210–215

    CAS  Google Scholar 

  17. Gould MK, Maclean CC, Kuschner WG et al. (2001) Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA 285: 914–924

    PubMed  Article  CAS  Google Scholar 

  18. Gurney JW, Lyddon DM, McKay JA (1993) Determining the likelihood of malignancy in solitary pulmonary nodules with Bayesian analysis. Part II. Application. Radiology 186: 415–422

    PubMed  CAS  Google Scholar 

  19. Hagberg RC, Segall GM, Stark P et al. (1997) Characterization of pulmonary nodules and mediastinal staging of bronchogenic carcinoma with F-18 fluorodeoxyglucose positron emission tomography. Eur J Cardiothorac Surg 12: 92–97

    PubMed  Article  CAS  Google Scholar 

  20. Henschke CI, McCauley DI, Yankelevitz DF et al. (1999) Early Lung Cancer Action Project: Overall design and findings from baseline screening. Lancet 354: 99–105

    PubMed  Article  CAS  Google Scholar 

  21. Lillington GA (1990) Decision analysis for management of solitary pulmonary nodules. Mayo Clin Proc 65: 1029–1030

    PubMed  CAS  Google Scholar 

  22. Murphy JM, Gleeson FV, Flower CD (2001) Percutaneous needle biopsy of the lung and its impact on patient management. World J Surg 25: 373–379

    PubMed  Article  CAS  Google Scholar 

  23. Nathan MH, Collins VP, Adams RA (1967) Differentiation of benign and malignant pulmonary nodules by growth rate. Radiology 79: 221–232

    Google Scholar 

  24. Nawa T, Nakagawa T, Kusano S et al. (2002) Lung cancer screening using low-dose spiral CT: results of baseline and 1-year follow-up studies. Chest 122: 15–20

    PubMed  Article  Google Scholar 

  25. Proto AV, Thomas SR (1985) Pulmonary nodules studied by computed tomographie. Radiology 156: 149–153

    PubMed  CAS  Google Scholar 

  26. Rubins JB, Rubins HB (1996) Temporal trends in the prevalence of malignancy in resected solitary pulmonary lesions. Chest 109: 100–103

    PubMed  CAS  Google Scholar 

  27. Schirren J, Muley T, Schneider P (1998) Chirurgische Therapie der Lungenmetastasen. In: Drings P, Vogt-Moykopf I (Hrsg) Thoraxtumoren. Springer, Berlin Heidelberg New York, S 640–669

  28. Schirren J, Trainer S, Schneider P et al. (1994) Sind videoassistierte thoraxchirurgische Resektionsverfahren in der onkologischen Chirurgie vertretbar? Chirurg 65: 664–670

    PubMed  CAS  Google Scholar 

  29. Schirren J, Wassenberg D, Krysa S et al. (1994) Surgery of lung metastasis–indications, results and prognostic factors as an interdisciplinary concept. Pneumologie 48: 469–474

    PubMed  CAS  Google Scholar 

  30. Swensen SJ, Jett JR, Sloan JA et al. (2002) Screening for lung cancer with low-dose spiral computed tomography. Am J Respir Crit Care Med 165: 508–513

    PubMed  Google Scholar 

  31. Swensen SJ, Silverstein MD, Ilstrup DM et al. (1997) The probability of malignancy in solitary pulmonary nodules. Application to small radiologically indeterminate nodules. Arch Intern Med 157: 849–855

    PubMed  Article  CAS  Google Scholar 

  32. Toomes H, Delphendahl A, Manke HG, Vogt-Moykopf I (1983) The coin lesion of the lung. Cancer 51: 534–537

    PubMed  Article  CAS  Google Scholar 

  33. Tuddenham WJ (1984) Glossary of terms for thoracic radiology: recommendations of the Nomenclature Committee of the Fleischner Society. AJR Am J Roentgenol 143: 509–517

    PubMed  CAS  Google Scholar 

  34. Weisbrod GL (1993) Transthoracic needle biopsy. World J Surg 17: 705–711

    PubMed  Article  CAS  Google Scholar 

  35. Westcott JL (1988) Percutaneous transthoracic needle biopsy. Radiology 169: 593–601

    PubMed  CAS  Google Scholar 

  36. White PG, Adams H, Crane MD et al. (1994) Preoperative staging of carcinoma of the bronchus: can computed tomographic scanning reliably identify stage III tumours? Thorax 49: 951–957

    PubMed  CAS  Article  Google Scholar 

  37. Yankelevitz DF, Gupta R, Zhao B et al. (1999) Small pulmonary nodules: evaluation with repeat CT–preliminary experience. Radiology 212: 561–566

    PubMed  CAS  Google Scholar 

  38. Yi CA, Lee KS, Kim BT et al. (2006) Tissue characterization of solitary pulmonary nodule: comparative study between helical dynamic CT and integrated PET/CT. J Nucl Med 47: 443–450

    PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Affiliations

  1. Klinik für Thoraxchirurgie, HSK, Dr-Horst-Schmidt-Kliniken, Ludwig-Erhardt-Straße 100, 65199, Wiesbaden, Deutschland

    T. Bergmann, S. Bölükbas, S. Beqiri, S. Trainer & J. Schirren

Authors
  1. T. Bergmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Bölükbas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Beqiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Trainer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Schirren
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Bergmann.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bergmann, T., Bölükbas, S., Beqiri, S. et al. Der solitäre Lungenrundherd. Chirurg 78, 687–697 (2007). https://doi.org/10.1007/s00104-007-1379-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-007-1379-4

Schlüsselwörter

  • Solitärer Lungenrundherd
  • Lungenkarzinom
  • Lungenmetastasen
  • Videoassistierte Thorakoskopie
  • Thorax-CT

Keywords

  • Chest computed tomography
  • Lung cancer
  • Pulmonary metastases
  • Solitary pulmonary nodule
  • Video-assisted thoracoscopy