ObjectiveTo 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. MethodsWe 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. ResultsThere 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. ConclusionAbove clinical strategies are accurate for early diagnosis and minimally invasive treatment of SPN with good postoperative recovery and short-term outcomes.