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A plea for thoracoscopic resection of solitary pulmonary nodule in cancer patients

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Abstract

Background

Solitary pulmonary nodules (SPN) are frequently detected in cancer patients. These lesions are often considered as pulmonary metastases and increasingly treated by non-surgical techniques without histological confirmation. The aim of this study is to determine the histological nature of SPN resected by thoracoscopy and to identify risk factors of malignancy.

Methods

Single-institution retrospective analysis of all consecutive patients with previously known malignancies who underwent thoracoscopic resection of SPN with unknown diagnosis between 2001 and 2014.

Results

One hundred and forty cancer patients underwent thoracoscopic resection of a SPN. The resected SPN was benign in 34 patients (24.3%) and malignant in 106 patients. The latter were metastasis in 70 patients (50%) and a primary lung cancer in 36 patients (25.7%). Upon univariate analysis, malignancy was significantly associated with age >60 years, disease-free interval ≥24 months, SPN size >8 mm, upper lobe localization and SUVmax > 2.5 on PET-CT. Upon multivariate analysis, upper lobe localization and SUVmax > 2.5 were associated with malignancy. Smoking was significantly associated with SPN containing primary lung cancer.

Conclusion

In this series, only 50% of SPN in patients with known malignant disease were pulmonary metastases and 25% had a newly diagnosed NSCLC. Smoking was associated with primary lung cancer but no other predictor was found to allow the distinction between pulmonary metastasis and lung cancer. These results endorse the need of histological confirmation of SPN in patients with previous malignancies to avoid diagnostic uncertainty and suboptimal treatments.

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Acknowledgements

We would like to acknowledge Matthieu Zellweger for his corrections and suggestions.

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Authors and Affiliations

  1. Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland

    Jocelyn Bellier, Jean Yannis Perentes, Etienne Abdelnour-Berchtold, Thorsten Krueger, Hans-Beat Ris & Michel Gonzalez

  2. Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    Catherine Beigelman-Aubry

  3. GIVRE – MERCS - Module d’Enseignement et de Recherche Collaboratifs en Statistiques, Univ. Lille, 59000, Lille, France

    Benjamin Lopez

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  1. Jocelyn Bellier
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  2. Jean Yannis Perentes
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  3. Etienne Abdelnour-Berchtold
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  7. Hans-Beat Ris
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  8. Michel Gonzalez
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Correspondence to Michel Gonzalez.

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Disclosures

Jocelyn Bellier, Jean Yannis Perentes, Etienne Abdelnour-Berchtold, Benjamin Lopez, Thorsten Krueger, Catherine Beigelman-Aubry, Hans-Beat Ris, and Michel Gonzalez have no conflicts of interest or financial ties to disclose.

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Bellier, J., Perentes, J.Y., Abdelnour-Berchtold, E. et al. A plea for thoracoscopic resection of solitary pulmonary nodule in cancer patients. Surg Endosc 31, 4705–4710 (2017). https://doi.org/10.1007/s00464-017-5543-8

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  • DOI: https://doi.org/10.1007/s00464-017-5543-8

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