Prevalence of benign disease in patients undergoing resection for suspected lung cancer - Discussion
Prevalence of benign disease in patients undergoing resection for suspected lung cancer - Discussion
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DOI：
10.1016/j.athoracsur.2005.11.010
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发表时间：
2006-05-01
影响因子：
4.6
通讯作者：
Benfield, JR
中科院分区：
文献类型：
--
作者：
Smith, MA;Battafarano, RJ;Benfield, JR
背景资料。在这个扩大肺癌筛查的时代，准确区分良恶性病变仍然是一个重要的问题。我们试图描述我们的肺局灶性病变的经验，提示肺癌，随后在手术切除时被证明是良性的。对1995年1月至2002年12月在我所接受肺内局灶性病变切除的1560例患者进行了回顾性分析。复习所有患者的计算机断层扫描和病理报告。对43例患者进行了氟-18-氟脱氧葡萄糖正电子发射断层扫描。病理检查发现良性病变140例(9%)。采用开胸手术103例(74%)，电视胸腔镜术36例(26%)，胸骨切开1例(0.7%)。70例(50%)患者在切除前接受了纵隔镜检查。围手术期死亡1例(0.7%)。病理诊断：肉芽肿性炎症91例(65%)，错构瘤17例(12%)，肺炎或肺炎14例(10%)，纤维化5例(4%)，其他13例(9%)。43例患者中22例为恶性病变，20例为良性病变(1例研究无法解释)。38例患者在手术前接受了针吸活检。其中29例为非诊断，5例为阴性，4例为阳性。尽管进行了彻底的临床评估、先进的成像技术和针吸活组织检查，许多患者仍继续接受良性疾病的手术。诊断和治疗早期肺癌的积极尝试必须与这一理解相结合。
Background. In this era of expanded lung cancer screening, accurate differentiation of benign from malignant lesions remains an important problem. We sought to characterize our experience with focal pulmonary lesions suggestive of lung cancer and subsequently proven benign on surgical resection.Methods. A retrospective analysis was performed on 1,560 patients who underwent resection for focal pulmonary lesions at our institution from January 1995 to December 2002. Computed tomography and pathology reports were reviewed for all patients. Fluorine-18-fluorodeoxyglucose positron emission tomography studies were performed on 43 patients.Results. Benign processes were found on pathologic examination in 140 patients (9%). Resection was accomplished by thoracotomy in 103 patients (74%), video-assisted thoracoscopy in 36 patients (26%), and sternotomy in 1 patient (0.7%). Seventy patients (50%) underwent mediastinoscopy before resection. There was 1 (0.7%) perioperative death. Pathologic diagnoses from the pulmonary resections revealed granulomatous inflammation in 91 patients (65%), hamartoma in 17 patients (12%), pneumonia or pneumonitis in 14 patients (10%), fibrosis in 5 patients (4%), and other in 13 patients (9%). Fluorine-18-fluorodeoxyglucose positron emission tomography imaging suggested malignancy in 22 of 43 patients and benign lesion in 20 of 43 patients (1 study was not interpretable). Thirty-eight patients underwent needle biopsy before surgery. Of these, 29 samples were nondiagnostic, 5 samples were negative, and 4 samples were considered positive for malignancy.Conclusions. Despite thorough clinical assessment, advanced imaging technology, and needle biopsy, many patients continue to undergo surgery for benign disease. Aggressive attempts to diagnose and treat early stage lung cancer must be tempered with this understanding.