Background and aims: The solitary pulmonary nodule (SPN) is a common clinical problem usually detected incidentally during screening tests for lung cancer. Video-assisted thoracoscopic surgery (VATS) is performed for diagnosing SPNs when there are technical difficulties with transthoracic needle aspiration biopsy or bronchoscopic biopsy, inconclusive biopsy results, or when there is a high suspicion of malignancy. This study aimed to identify factors that can reduce unnecessary VATS for the diagnosis of SPNs.
Methods: We retrospectively analysed patients with SPNs (n = 107) who had undergone diagnostic VATS at Seoul National University Hospital from January 2007 to December 2008. Clinical and radiological parameters were evaluated to compare benign and malignant SPNs.
Results: Benign SPNs were diagnosed in 31 patients (29.0%). The most common reason for patients to undergo a diagnostic VATS was a history of malignancy. The most common histological findings in patients with benign SPNs were non-specific inflammatory lesions (29.0%) and tuberculosis (16.1%). The presence of respiratory symptoms was significantly associated with benign diseases [P = 0.004, odds ratio (OR) 0.189, 95% confidence interval (CI) 0.060-0.590], and part-solid nodules were significantly related to malignancy (P = 0.026, OR 6.34, 95% CI 1.248-32.169).
Conclusion: Approximately 30% of SPNs resected by VATS were benign. Although we did not identify a definite factor for predicting benign disease or malignancy, the presence of respiratory symptoms was related to benign disease, and part-solid nodules were associated with malignancy.
Keywords: respiratory signs and symptoms; solitary pulmonary nodule; video-assisted thoracoscopic surgery.
© 2014 John Wiley & Sons Ltd.