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.	劉彥國.肺內小結節的診治現狀、問題和方向.中華胸心血管外科雜志, 2012, 28(7):385-386, 389.
2.	單立群, 胡堅, 李明東, 等.胸腔鏡在肺部微小結節診治中的應用.中國肺癌雜志, 2013, 16(7):369-372.
3.	袁海云, 夏旭, 胡寧東, 等.孤立性肺結節患者臨床預測模型的對比分析.中華肺部疾病雜志, 2013, 6(5):47-49.
4.	王濤, 陳寶俊, 范曉紅, 等.肺微小結節的臨床診斷與治療.中國胸心血管外科臨床雜志, 2012, 19(3):274-279.
5.	趙肖, 王孟昭.肺癌血清腫瘤標志物的臨床意義.中國肺癌雜志, 2011, 14(3):286-291.
6.	夏旭, 胡寧東, 袁海云, 等.孤立性肺結節病變性質臨床鑒別診斷預測模型的初探.中華肺部疾病雜志, 2012, 5(3):265-269.
7.	常亮, 張鑄.肺部周圍球形病灶誤診原因分析.中國胸心血管外科臨床雜志, 2012, 19(3):331-333.
8.	楊小平, 莫紹雄, 莫安勝, 等.孤立性肺結節65例分析.實用醫學雜志, 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.	陳海泉.肺部孤立性結節診治進展.癌癥進展, 2011, 9(5):472-478.
11.	梁冰, 趙輝, 車建波, 等.電視胸腔鏡手術在孤立性肺結節診斷和治療中的應用價值.中國現代藥物應用, 2014, 8(1):103-104.
12.	賈春祎, 陳海泉, 王啟文, 等. CT引導Hookwire定位下電視胸腔鏡手術對孤立性肺小結節的診療價值.中國癌癥雜志, 2013, 23(11):917-920.
13.	葉仕新, 曾志勇, 徐馳, 等.電視胸腔鏡在肺部小結節診斷與治療中的應用.中國胸心血管外科臨床雜志, 2012, 19(5):567-568.
14.	沈雪峰, 袁德全, 岳明, 等. CT引導下帶鉤鋼絲合并美蘭染色術前定位在胸腔鏡孤立性肺結節切除術中的臨床應用.實用醫學雜志, 2012, 28(18):3154-3155.
15.	邱寧雷, 張治, 莊一平, 等.肺部小結節胸腔鏡術前CT引導下硬化劑定位的臨床應用價值.中華胸心血管外科雜志, 2012, 28(7):398-400.
16.	詹必成, 陳亮, 朱全, 等. CT引導下亞甲藍與Hookwire聯合術前定位在胸腔鏡下孤立性肺小結節切除術中的應用.中華臨床醫師雜志, 2011, 5(9):2713-2716.
17.	熊磊, 許健, 易俊, 等. CT引導彈簧圈定位在胸腔鏡切除孤立肺結節的應用.東南國防醫藥, 2013, 15(4):329-331.
18.	劉道明, 周順楷, 花梅免, 等. 109枚直徑小于20mm的肺內結節的胸腔鏡診療.中華胸心血管外科雜志, 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.	肖飛, 梁朝陽.孤立性肺結節的良惡性判斷及外科診治進展.中華胸心血管外科雜志, 2013, 29(7):434-436.
23.	林志潮, 伍碩允, 葉敏, 等.肺小結節術前CT引導下亞甲藍定位的臨床應用.中山大學學報:醫學科學版, 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.	張菁, 馬靖, 王廣發.實性和亞實性肺結節臨床處理——ACCP最新肺結節診療指南簡介.中華結核和呼吸雜志, 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. 劉彥國.肺內小結節的診治現狀、問題和方向.中華胸心血管外科雜志, 2012, 28(7):385-386, 389.
2. 單立群, 胡堅, 李明東, 等.胸腔鏡在肺部微小結節診治中的應用.中國肺癌雜志, 2013, 16(7):369-372.
3. 袁海云, 夏旭, 胡寧東, 等.孤立性肺結節患者臨床預測模型的對比分析.中華肺部疾病雜志, 2013, 6(5):47-49.
4. 王濤, 陳寶俊, 范曉紅, 等.肺微小結節的臨床診斷與治療.中國胸心血管外科臨床雜志, 2012, 19(3):274-279.
5. 趙肖, 王孟昭.肺癌血清腫瘤標志物的臨床意義.中國肺癌雜志, 2011, 14(3):286-291.
6. 夏旭, 胡寧東, 袁海云, 等.孤立性肺結節病變性質臨床鑒別診斷預測模型的初探.中華肺部疾病雜志, 2012, 5(3):265-269.
7. 常亮, 張鑄.肺部周圍球形病灶誤診原因分析.中國胸心血管外科臨床雜志, 2012, 19(3):331-333.
8. 楊小平, 莫紹雄, 莫安勝, 等.孤立性肺結節65例分析.實用醫學雜志, 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. 陳海泉.肺部孤立性結節診治進展.癌癥進展, 2011, 9(5):472-478.
11. 梁冰, 趙輝, 車建波, 等.電視胸腔鏡手術在孤立性肺結節診斷和治療中的應用價值.中國現代藥物應用, 2014, 8(1):103-104.
12. 賈春祎, 陳海泉, 王啟文, 等. CT引導Hookwire定位下電視胸腔鏡手術對孤立性肺小結節的診療價值.中國癌癥雜志, 2013, 23(11):917-920.
13. 葉仕新, 曾志勇, 徐馳, 等.電視胸腔鏡在肺部小結節診斷與治療中的應用.中國胸心血管外科臨床雜志, 2012, 19(5):567-568.
14. 沈雪峰, 袁德全, 岳明, 等. CT引導下帶鉤鋼絲合并美蘭染色術前定位在胸腔鏡孤立性肺結節切除術中的臨床應用.實用醫學雜志, 2012, 28(18):3154-3155.
15. 邱寧雷, 張治, 莊一平, 等.肺部小結節胸腔鏡術前CT引導下硬化劑定位的臨床應用價值.中華胸心血管外科雜志, 2012, 28(7):398-400.
16. 詹必成, 陳亮, 朱全, 等. CT引導下亞甲藍與Hookwire聯合術前定位在胸腔鏡下孤立性肺小結節切除術中的應用.中華臨床醫師雜志, 2011, 5(9):2713-2716.
17. 熊磊, 許健, 易俊, 等. CT引導彈簧圈定位在胸腔鏡切除孤立肺結節的應用.東南國防醫藥, 2013, 15(4):329-331.
18. 劉道明, 周順楷, 花梅免, 等. 109枚直徑小于20mm的肺內結節的胸腔鏡診療.中華胸心血管外科雜志, 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. 肖飛, 梁朝陽.孤立性肺結節的良惡性判斷及外科診治進展.中華胸心血管外科雜志, 2013, 29(7):434-436.
23. 林志潮, 伍碩允, 葉敏, 等.肺小結節術前CT引導下亞甲藍定位的臨床應用.中山大學學報:醫學科學版, 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. 張菁, 馬靖, 王廣發.實性和亞實性肺結節臨床處理——ACCP最新肺結節診療指南簡介.中華結核和呼吸雜志, 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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