HASİBE ÇİĞDEM ERTEN, ERDEM EMRE GÜLŞEN, SEVDA ŞENER CÖMERT, NESRİN KIRAL, KADİR BURAK ÖZER, RECEP DEMİRHAN
Southern Clinics of Istanbul Eurasia - 2023;34(4):295-300
INTRODUCTION: The primary goal in solitary pulmonary nodule (SPN) management is to distinguish malignant lesions from benign ones. In our study, we aimed to evaluate the follow-up results, malignancy rates, and risk factors for malignancy of SPNs, which were discussed in our multidisciplinary lung cancer council (MLCC) with suspicion of malignancy and decided for surgical treatment. METHODS: Cases that were decided for surgical diagnosis and treatment after evaluation in the council were included in our study, which was planned prospectively. Demographic features, nodulsize, radiological features, location, Positron Emission Tomography (PET) findings, whether bronchoscopy and endobronchial ultrasonography were performed and their results, duration of follow-up before surgery, interventions and their results made for diagnosis, surgical method performed, and the final diagnosis were recorded. Chi-square and MannWhitney U tests were used in statistical analysis. Results: Of the 33 cases in our study, 10 (30.3%) were female and 23 (69.7%) were male; the average age was 60.2±7.9 (min: 42;max: 77) years. The average diameter of SPN was measured as 16.5±6.3 (min: 7; max: 30) mm. When looking at their locations, it was seen that 72.7% were located in the upper lobes. 75.8% of the nodules were solid in character, 39.4% had spiculated contours, and 33.3% had lobulated contours. There was no calcification in 87.9% of the nodules. In the PET computed tomography examination, the average SUVmax value of nodules was measured as 6.05±6.01 (min: 0; max: 22), and there was no FDG uptake in the mediastinal lymph nodes of 21 (63.6%) cases. Surgical intervention was decided in 27 (81.8%) cases without a diagnosis. The final diagnosis was malignancy in 69.7% of cases. A statistically significant correlation was found between the final diagnosis and the edge features of the nodule and the SUVmax value (p=0.021, p=0.048, respectively). DISCUSSION AND CONCLUSION: Since SPN can represent early-stage primary lung cancer, risk factors and radiological features for each patient in SPN management should be individually assessed, and decisions should be made with a multidisciplinary approach. The aim is to minimize the outcomes of over-investigation, including patient anxiety and cumulative radiation exposure, while identifying nodules representing early malignancy.
