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.
More and more solitary pulmonary nodules (SPN) are discovered with the development of imaging technology. Early and appropriate evaluation of SPN is of great importance for following treatment and patients' prognosis, as early differentiation between benign and malignant is difficult, while its possibility of being malignant does exist. In this review, we make a comprehensive evaluation about diagnostic value of some risk factors of solitary pulmonary nodules, including age, nodule diameter, doubling time, nodule location, air bronchogram, ground-glass opacitie, vacuole, lobulation, spiculation, vascular convergence, pleural indentation, nodule calcification, past medical history, smoking history, past symptoms and nodule density. Future perspective of diagnostic strategies is also discussed.
ObjectiveTo compare solitary pulmonary nodule resection via thoracoscopic 3D mode or 2D mode and to further evaluate the clinical application value of thoracoscopic 3D mode. MethodsWe retrospectively analyzed the clinical data of 120 patients with solitary pulmonary nodule between March 2013 and March 2014 in the First Hospital Affiliated to Xiamen University. The patients were allocated into two groups including a 3D-VATS group (50 patients) and a 2D-VATS group (70 patients). Pulmonary partial resection was performed firstly. Pulmonary lobectomy would be conducted or not on the basis of intra operative rapid pathological results. ResultsTwenty three patients were performed 3D-VATS in the 3D-VATS group. Twenty-nine patients were diagnosed as pathological malignancy underwent lobectomy plus partial dissection. There were statistical differences between the 3D-VATS group and the 2D-VATS group in operative time (t=1.967, P<0.05), intra operative blood loss (t=7.85, P<0.05), drainage volume 24 h after operation (t=6.18, P<0.05), postoperative chest tube retention time (t=7.1, P<0.05), and postoperative hospital stay (t=2.35, P<0.05). Following-up time in the 3D-VATS group was 6.3 (2-12) months. Complications occurred in 3 patients, including 2 patients with postoperative pneumonia and 1 patient with paroxysmal atrial fibrillation in the 3D-VATS group. The following-up time in the 2D-VATS group was 8.2 (2-15) months. Complications occurred in 4 patients, including 1 patient with chylous hydrothorax, 2 patients with pneumothorax, 1 patient with delayed pulling up the chest closed drainage in the 2D-VATS group. The patients in both groups with complications were cured by appropriate treatment. Conclusion3D-VAST for SPN is a new operation mode choice. It is safe and feasible with low incidence of postoperative complications. Surgery vision, stereo feeling, the operation of adaptation, and postoperative recovery have certain advantages. It is worthy popularizing.
ObjectiveTo investigate the heterogeneity of gut microbiota between patients with solitary pulmonary nodules (SPN) and multiple pulmonary nodules (MPN), and to explore the intrinsic relationship between Traditional Chinese Medicine (TCM) constitution types and the intestinal microecology. MethodsA prospective study was conducted on 280 patients with pulmonary nodules enrolled between April 2022 and December 2024 from Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan Cancer Hospital, Chengdu Integrated Traditional Chinese Medicine & Western Medicine Hospital. Among them, 118 (42.1%) were male and 162 (57.9%) were female, with a median age of 50 (42, 57) years. Based on imaging findings, patients were divided into a SPN group (n=65) and an MPN group (n=215). TCM constitution types were identified using a Constitution in Chinese Medicine Questionnaire. Fecal samples were collected for 16S rRNA sequencing. Bioinformatics analysis was employed to analyze inter-group differences in microbial community structure. The correlation between TCM constitutions and gut microbiota was examined using Procrustes analysis and Spearman correlation analysis. ResultsThe distribution of TCM constitution types between the two groups showed a statistically significant difference (P<0.05). The SPN group was predominantly characterized by the Qi-depression constitution, while the MPN group was more commonly associated with Yang-deficiency and Phlegm-dampness constitutions. Microbiota analysis revealed that the gut microbiota health index was significantly higher in the SPN group than in the MPN group (P<0.05), whereas the microbiota dysbiosis index showed the opposite pattern. Taxonomic analysis identified higher abundances of Ruminococcus_torques_group, Haemophilus, and Fusobacterium in the SPN group. The abundance of Leuconostoc was significantly increased in the MPN group. Procrustes analysis and Spearman correlation analysis indicated that in the SPN group, the Qi-depression constitution was positively correlated with Ruminococcus_torques_group and Bacteroides. In the MPN group, the Yang-deficiency constitution was negatively correlated with Faecalibacterium, while no statistically significant correlations were found between specific bacterial genera and the Phlegm-dampness or Qi-deficiency constitutions. ConclusionSPN and MPN exhibit significant heterogeneity in TCM constitutional tendencies and microecological characteristics. The abundance of specific bacterial genera may serve as potential biomarkers for distinguishing between SPN and MPN. The interaction between TCM constitutions and specific gut microbiota provides a theoretical basis for the precise TCM syndrome differentiation and microecological intervention in pulmonary nodules.
Diagnosis and treatment of solitary pulmonary nodule (SPN, less than 30 mm in diameter) has been a formidable problem in clinical work. It is often detected in medical examination or other disease examinations by chance. There are no corresponding signs and symptoms of SPN except those on the imaging, so it is difficult to make a correct diagnosis as early as possible. Literature shows that there is a certain probability of malignant SPN, so early correct diagnosis is the key factor in deciding the prognosis and appropriate treatment. With the accumulation of clinical experiences, the development of new fiberoptic bronchoscopy, highresolution CT, and videoassisted thoracoscopic surgery, as well as the evolution of some invasive examination technologies, it is less difficult in distinguishing benign from malignant SPN than ever before. In this article, we will make a comprehensive review on the development in the aspect of differential diagnosis of SPN.
Objective To identify risk factors that affect the verification of malignancy in patients with solitary pulmonary nodule (SPN) and verify different prediction models for malignant probability of SPN. Methods We retrospectively analyzed the clinical data of 117 SPN patients with definite postoperative pathological diagnosis who underwent surgical procedure in China-Japan Friendship Hospital from March to September 2017. There were 59 males and 58 females aged 59.10±11.31 years ranging from 24 to 83 years. Imaging features of the nodule including maximum diameter, location, spiculation, lobulation, calcification and serum level of CEA and Cyfra21-1 were assessed as potential risk factors. Univariate analysis was used to establish statistical correlation between risk factors and postoperative pathological diagnosis. Receiver operating characteristic (ROC) curve was drawn by different predictive models for the malignant probability of SPN to get areas under the curves (AUC), sensitivity, specificity, positive predictive values, negative predictive values for each model. The predictive effectiveness of each model was statistically assessed subsequently. Results Among 117 patients, 93 (79.5%) were malignant and 24 (20.5%) were benign. Statistical difference was found between the benign and malignant group in age, maximum diameter, serum level of CEA and Cyfra21-1, spiculation, lobulation and calcification of the nodules. The AUC value was 0.813±0.051 (Mayo model), 0.697±0.066 (VA model) and 0.854±0.045 (Peking University People's Hospital model), respectively. Conclusion Age, maximum diameter of the nodule, serum level of CEA and Cyfra21-1, spiculation, lobulation and calcification are potential independent risk factors associated with the malignant probability of SPN. Peking University People's Hospital model is of high accuracy and clinical value for patients with SPN. Adding serum index into the prediction model as a new risk factor and adjusting the weight of age in the model may improve the accuracy of prediction for SPN.
Objective To evaluate the value of incremental dynamic enhanced computer tomography (CT) in diagnosis of solitary pulmonary nodules (SPN). Methods The data of 42 cases with SPN who had undergone pulmonary lobectomy were collected retrospectively to find the relationship between character of preoperative dynamic enhanced CT image and postoperative pathologic result. Results All bronchogenic carcinoma showed significant enhancement after intravenous 100 ml iodinated contrast material. The average degree of enhancement of bronchogenic carcinoma during the time 85s and 135s after infusion was significantly different from that of tuberculoma and other benign lesions(Plt;0.05). Conclusion Dynamic enhanced CT is valuable in identifying the malignant nodules from benign nodules. Emphasis should be paid to the lymph nodes in the relative field with dynamic enhanced CT, which is beneficial to the diagnosis of SPN and it is an important predictor of the result of surgical treatment.
Objective To analyze the imaging features of solitary pulmonary nodules ( SPNs) , and compare the two types of lung cancer prediction models in distinguishing malignancy of SPNs.Methods A retrospective study was performed on the patients admitted to Ruijin Hospital between 2002 and 2009 with newly discovered SPNs. The patients all received pathological diagnosis. The clinical and imaging characteristics were analyzed. Then the diagnostic accuracy of two lung cancer prediction models for distinguishing malignancy of SPNs was evaluated and compared.Results A total of 90 patients were enrolled, of which 32 cases were with benign SPNs, 58 cases were with malignant SPNs. The SPNs could be identified between benign and maligant by the SPN edge features of lobulation ( P lt;0. 05) . The area under ROC curve of VA model was 0. 712 ( 95% CI 0. 606 to 0. 821) . The area under ROC curve of Mayo Clinic model was 0. 753 ( 95% CI 0. 652 to 0. 843) , which was superior to VA model. Conclusions It is meaningful for the identification of benign and maligant SPNs by the obulation sign in CT scan. We can integrate the clinical features and the lung cancer predicting models to guide clinical work.
With widespread utilization of multi-slice helical computed tomography (CT) and low-dose CT in lung cancer screening, significantly greater incidence of patients with solitary pulmonary nodules (SPN) has been found. Once SPN is discovered, it is very difficult to immediately determine whether it is benign or malignant in clinical practice. In this review, SPN etiology, epidemiological characteristics of SPN patients, nodule size, morphology, location and growth rate, mathematical models for predicting malignancy of SPN, and diagnostic value of positron emission tomography (PET) and positron emission tomography-computed tomography (PET/CT) are summarized to provide reference for differential diagnosis of SPN. Current management strategies for SPN are also discussed in this review. According to whether SPN diameter is greater than 8 mm, whether SPN patients are advanced aged, have smoking or malignancy history, different follow-up and treatment strategies can be chosen. The diagnostic and treatment value of video-assisted thoracoscopic surgery for SPN is also discussed.
ObjectiveTo summarize the experience of diagnosis and surgical treatment for solitary pulmonary nodules (SPN). MethodsWe retrospectively analyzed clinical data of 327 patients with video-assisted thoracoscopic surgery (VATS) lung resections and subsequent pathological diagnosis of the SPNs in Daping Hospital from January 2008 through May 2014 year. There were 183 males, 144 females at age of 56.6(20-79) years. ResultsOne way analysis of variance showed that there were significant differences in age, smoking index, diameter, glitches, lobulation, traction of pleural, cavity, vascular convergence, calcification between benign and malignant lesions (P<0.05). Logistic regression analysis revealed that age (P=0.004, OR=1.084), diameter (P<0.001, OR=1.467), glitches (P=0.001, OR=8.754), lobulation (P<0.001, OR=10.424), traction of pleural (P=0.002, OR=6.619) were independent predictors of malignancy in patients with SPN. Operation time was 121.4±47.6 min. Blood loss was 105.3±57.8 ml. Postoperative hospital stay was 7.3±2.4 days. Diagnostic accuracy was 99.7%. Incidence of complication was 0.5%. Five (1.5%) patients were converted to thoracotomy and no perioperative death occurred. ConclusionsAge, diameter, glitches, lobulation, traction of pleural are independent predictors of malignancy in the patients with SPN. VATS is a safe and efficient method for diagnosis and treatment of SPN.