Early Diagnosis and Treatment of Solitary Pulmonary Nodules_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIXiao-xiang ¹ ,  LÜBi-hong ¹ , HEGuang-ming ¹ , HEJian-ming ¹ , CHENRui ¹ , YETing ² , LUANCui-fang ¹

1. Department of Thoracic Surgery, Taixing People's Hospital, Affiliated Hospital of Medical School of Yangzhou University, Taixing 225400, Jiangsu, P. R. China;
2. Department of Clinical Laboratory, Taixing People's Hospital, Affiliated Hospital of Medical School of Yangzhou University, Taixing 225400, Jiangsu, P. R. China;

Corresponding author：

LÜBi-hong, Email: ZXXXX7576@163.com

Keywords：

Solitary pulmonary nodule; Biological tumor marker; Video-assisted thoracoscopic surgery; Diagnosis; Treatment

DOI：

10.7507/1007-4848.20140227

Video：

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Objective To explore clinical strategies of early diagnosis and treatment of solitary pulmonary nodules (SPN), and define the importance of biological tumor markers, preoperative CT-guided localization with the combination of methylene blue and hookwire system, and video-assisted thoracoscopic surgery (VATS)for early diagnosis and treatment of SPN. Methods We retrospectively analyzed clinical records of 70 SPN patients in Department of Thoracic Surgery of Taixing People's Hospital from January 2011 to February 2014. There were 33 male and 37 female patients with their age of 32-87 (59.74±2.04)years. Preoperatively, patients' medical history, heart, lung, liver and kidney function, sputum cytology and bronchoscopic biopsy results were combined with biological tumor markers to make a preliminary differential diagnosis between benign or malignant SPN and surgical risk evaluation. For SPN less than 1 cm or too small for accurate intraoperative localization, CT-guided localization with the combination of methylene blue and hookwire system was routinely performed half an hour before the operation. For SPN large enough for accurate intraoperative localization, wedge resection of SPN and surrounding lung tissue was directly performed with VATS. Intraoperative frozen-section examination of resected lung specimens was preformed. If the pathological diagnosis was malignant, conventional VATS lobectomy/segmentectomy and lymphadenectomy were performed. If the pathological diagnosis was benign, the operation was then completed. Long-term follow-up was performed for SPN patients, especially patients with early-stage lung cancer. Results There was no in-hospital death or postoperative bronchopleural fistula in this study. Postoperatively, there were 2 patients with pneumonia, 3 patients with pneumothorax and 1 patient with wound infection, who were all cured or improved after proper treatment. Among the 70 patients, 11 patients acquired pathological diagnosis via preoperative lung needle biopsy. Among the other 59 patients, 12 patients with eccentric SPN acquired pathological diagnosis via intraoperative biopsy, and 47 patients underwent SPN resection with VATS. Pathological diagnosis included adenocarcinoma in 19 patients, squamous cell carcinoma in 9 patients, bronchioloalveolar carcinoma in 3 patients, adenosquamous carcinoma in 2 patients, inflammatory pseudotumor in 11 patients, tuberculoma in 4 patients, granuloma in 5 patients, sclerosing hemangioma in 2 patients, lung metastasis from breast cancer in 1 patient, lung metastasis from colon cancer in 1 patient, lung metastasis from thyroid cancer in 1 patient, and lung metastasis from stomach cancer in 1 patient. All the 70 patients (100%)were followed up for a mean duration of 2-34 months, and there was no late death during follow-up. One patient with adenocarcinoma of the right upper lobe had cerebral metastasis 18 months after operation, and had been receiving radiotherapy. All the other patients had a good quality of life. Conclusion Above clinical strategies are accurate for early diagnosis and minimally invasive treatment of SPN with good postoperative recovery and short-term outcomes.

Citation： XIXiao-xiang, LÜBi-hong, HEGuang-ming, HEJian-ming, CHENRui, YETing, LUANCui-fang. Early Diagnosis and Treatment of Solitary Pulmonary Nodules. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 793-797. doi: 10.7507/1007-4848.20140227 Copy

1.	刘彦国.肺内小结节的诊治现状、问题和方向.中华胸心血管外科杂志, 2012, 28(7):385-386, 389.
2.	单立群, 胡坚, 李明东, 等.胸腔镜在肺部微小结节诊治中的应用.中国肺癌杂志, 2013, 16(7):369-372.
3.	袁海云, 夏旭, 胡宁东, 等.孤立性肺结节患者临床预测模型的对比分析.中华肺部疾病杂志, 2013, 6(5):47-49.
4.	王涛, 陈宝俊, 范晓红, 等.肺微小结节的临床诊断与治疗.中国胸心血管外科临床杂志, 2012, 19(3):274-279.
5.	赵肖, 王孟昭.肺癌血清肿瘤标志物的临床意义.中国肺癌杂志, 2011, 14(3):286-291.
6.	夏旭, 胡宁东, 袁海云, 等.孤立性肺结节病变性质临床鉴别诊断预测模型的初探.中华肺部疾病杂志, 2012, 5(3):265-269.
7.	常亮, 张铸.肺部周围球形病灶误诊原因分析.中国胸心血管外科临床杂志, 2012, 19(3):331-333.
8.	杨小平, 莫绍雄, 莫安胜, 等.孤立性肺结节65例分析.实用医学杂志, 2014, 30(4):669-669.
9.	Lazarus DR, Ost DE. The solitary pulmonary nodule-deciding when to act? Semin Respir Crit Care Med, 2013, 34(6):748-761.
10.	陈海泉.肺部孤立性结节诊治进展.癌症进展, 2011, 9(5):472-478.
11.	梁冰, 赵辉, 车建波, 等.电视胸腔镜手术在孤立性肺结节诊断和治疗中的应用价值.中国现代药物应用, 2014, 8(1):103-104.
12.	贾春祎, 陈海泉, 王启文, 等. CT引导Hookwire定位下电视胸腔镜手术对孤立性肺小结节的诊疗价值.中国癌症杂志, 2013, 23(11):917-920.
13.	叶仕新, 曾志勇, 徐驰, 等.电视胸腔镜在肺部小结节诊断与治疗中的应用.中国胸心血管外科临床杂志, 2012, 19(5):567-568.
14.	沈雪峰, 袁德全, 岳明, 等. CT引导下带钩钢丝合并美兰染色术前定位在胸腔镜孤立性肺结节切除术中的临床应用.实用医学杂志, 2012, 28(18):3154-3155.
15.	邱宁雷, 张治, 庄一平, 等.肺部小结节胸腔镜术前CT引导下硬化剂定位的临床应用价值.中华胸心血管外科杂志, 2012, 28(7):398-400.
16.	詹必成, 陈亮, 朱全, 等. CT引导下亚甲蓝与Hookwire联合术前定位在胸腔镜下孤立性肺小结节切除术中的应用.中华临床医师杂志, 2011, 5(9):2713-2716.
17.	熊磊, 许健, 易俊, 等. CT引导弹簧圈定位在胸腔镜切除孤立肺结节的应用.东南国防医药, 2013, 15(4):329-331.
18.	刘道明, 周顺楷, 花梅免, 等. 109枚直径小于20mm的肺内结节的胸腔镜诊疗.中华胸心血管外科杂志, 2012, 28(7):394-397.
19.	Kondo R, Yoshida K, Hamanaka K, et al. Intraoperative ultrasonographic localization of pulmonary ground-glass opacities. J Thorac Cardiovasc Surg, 2009, 138(4):837-842.
20.	Chen SF, Zhou JH, Zhang J, et al. Video-assisted thoracoscopic solitary pulmonary nodule resection after CT-guided hookwire localization:43 cases report and literature review. Surg Endosc, 2011, 25(6):1723-1729.
21.	Miyoshi K, Toyooka S, Gobara H, et al. Clinical outcomes of short hook wire and suture marking system in thoracoscopic resection for pulmonary nodules. Eur J Cardiothorac Surg, 2009, 36(2):378-382.
22.	肖飞, 梁朝阳.孤立性肺结节的良恶性判断及外科诊治进展.中华胸心血管外科杂志, 2013, 29(7):434-436.
23.	林志潮, 伍硕允, 叶敏, 等.肺小结节术前CT引导下亚甲蓝定位的临床应用.中山大学学报:医学科学版, 2013, 34(3):456-460.
24.	Shentu Y, Zhang L, Gu H, et al. A new technique combining virtual simulation and methylene blue staining for the localization of small peripheralpulmonary lesions. BMC Cancer, 2014, 14:79.
25.	张菁, 马靖, 王广发.实性和亚实性肺结节临床处理——ACCP最新肺结节诊疗指南简介.中华结核和呼吸杂志, 2014, 37(3):202-205.
26.	Marchevsky AM, Changsri C, Gupta I, et al. Frozen section diagnoses of small pulmonary nodules:accuracy and clinical implications. Ann Thorac Surg, 2004, 78(5):1755-1759.

1. 刘彦国.肺内小结节的诊治现状、问题和方向.中华胸心血管外科杂志, 2012, 28(7):385-386, 389.
2. 单立群, 胡坚, 李明东, 等.胸腔镜在肺部微小结节诊治中的应用.中国肺癌杂志, 2013, 16(7):369-372.
3. 袁海云, 夏旭, 胡宁东, 等.孤立性肺结节患者临床预测模型的对比分析.中华肺部疾病杂志, 2013, 6(5):47-49.
4. 王涛, 陈宝俊, 范晓红, 等.肺微小结节的临床诊断与治疗.中国胸心血管外科临床杂志, 2012, 19(3):274-279.
5. 赵肖, 王孟昭.肺癌血清肿瘤标志物的临床意义.中国肺癌杂志, 2011, 14(3):286-291.
6. 夏旭, 胡宁东, 袁海云, 等.孤立性肺结节病变性质临床鉴别诊断预测模型的初探.中华肺部疾病杂志, 2012, 5(3):265-269.
7. 常亮, 张铸.肺部周围球形病灶误诊原因分析.中国胸心血管外科临床杂志, 2012, 19(3):331-333.
8. 杨小平, 莫绍雄, 莫安胜, 等.孤立性肺结节65例分析.实用医学杂志, 2014, 30(4):669-669.
9. Lazarus DR, Ost DE. The solitary pulmonary nodule-deciding when to act? Semin Respir Crit Care Med, 2013, 34(6):748-761.
10. 陈海泉.肺部孤立性结节诊治进展.癌症进展, 2011, 9(5):472-478.
11. 梁冰, 赵辉, 车建波, 等.电视胸腔镜手术在孤立性肺结节诊断和治疗中的应用价值.中国现代药物应用, 2014, 8(1):103-104.
12. 贾春祎, 陈海泉, 王启文, 等. CT引导Hookwire定位下电视胸腔镜手术对孤立性肺小结节的诊疗价值.中国癌症杂志, 2013, 23(11):917-920.
13. 叶仕新, 曾志勇, 徐驰, 等.电视胸腔镜在肺部小结节诊断与治疗中的应用.中国胸心血管外科临床杂志, 2012, 19(5):567-568.
14. 沈雪峰, 袁德全, 岳明, 等. CT引导下带钩钢丝合并美兰染色术前定位在胸腔镜孤立性肺结节切除术中的临床应用.实用医学杂志, 2012, 28(18):3154-3155.
15. 邱宁雷, 张治, 庄一平, 等.肺部小结节胸腔镜术前CT引导下硬化剂定位的临床应用价值.中华胸心血管外科杂志, 2012, 28(7):398-400.
16. 詹必成, 陈亮, 朱全, 等. CT引导下亚甲蓝与Hookwire联合术前定位在胸腔镜下孤立性肺小结节切除术中的应用.中华临床医师杂志, 2011, 5(9):2713-2716.
17. 熊磊, 许健, 易俊, 等. CT引导弹簧圈定位在胸腔镜切除孤立肺结节的应用.东南国防医药, 2013, 15(4):329-331.
18. 刘道明, 周顺楷, 花梅免, 等. 109枚直径小于20mm的肺内结节的胸腔镜诊疗.中华胸心血管外科杂志, 2012, 28(7):394-397.
19. Kondo R, Yoshida K, Hamanaka K, et al. Intraoperative ultrasonographic localization of pulmonary ground-glass opacities. J Thorac Cardiovasc Surg, 2009, 138(4):837-842.
20. Chen SF, Zhou JH, Zhang J, et al. Video-assisted thoracoscopic solitary pulmonary nodule resection after CT-guided hookwire localization:43 cases report and literature review. Surg Endosc, 2011, 25(6):1723-1729.
21. Miyoshi K, Toyooka S, Gobara H, et al. Clinical outcomes of short hook wire and suture marking system in thoracoscopic resection for pulmonary nodules. Eur J Cardiothorac Surg, 2009, 36(2):378-382.
22. 肖飞, 梁朝阳.孤立性肺结节的良恶性判断及外科诊治进展.中华胸心血管外科杂志, 2013, 29(7):434-436.
23. 林志潮, 伍硕允, 叶敏, 等.肺小结节术前CT引导下亚甲蓝定位的临床应用.中山大学学报:医学科学版, 2013, 34(3):456-460.
24. Shentu Y, Zhang L, Gu H, et al. A new technique combining virtual simulation and methylene blue staining for the localization of small peripheralpulmonary lesions. BMC Cancer, 2014, 14:79.
25. 张菁, 马靖, 王广发.实性和亚实性肺结节临床处理——ACCP最新肺结节诊疗指南简介.中华结核和呼吸杂志, 2014, 37(3):202-205.
26. Marchevsky AM, Changsri C, Gupta I, et al. Frozen section diagnoses of small pulmonary nodules:accuracy and clinical implications. Ann Thorac Surg, 2004, 78(5):1755-1759.

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Early Diagnosis and Treatment of Solitary Pulmonary Nodules

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