Solitary pulmonary nodules: pathological outcome of 150 consecutively resected lesions

We investigated the pathological outcome of lung resections undertaken for solitary pulmonary nodules (SPNs) <30 mm in diameter in a regional thoracic practice serving a population historically engaged in heavy and light industry together with high tobacco use. Analysis of data collected prospectively on patients undergoing open lung resection between 1998 and 2003 for SPNs <30 mm in diameter. Demographics, operative and pathological details were sought from files and electronic records. One hundred and fifty patients (80 men), underwent lung resection during the study period. Mean age at resection was 64.7 years. Mean nodule diameter was 17.6 mm as measured by CT. Eighty-seven lobectomies, nine bilobectomies, 51 wedge excisions and one pneumonectomy were performed via open approaches. Frozen section was used selectively and anatomical resection performed where feasible. Malignancy was identified in 115 patients (77.7%): 97 (65.5%) with primary lung pathology; 18 (12.2%) had metastatic deposits; 30 (20.3%) were benign. There was no significant correlation between nodule size and malignancy risk (P>0.05). An appreciation of cancer risk is crucial to the informed counselling and intelligent management of patients presenting with lung masses. In this cohort 78% of the SPNs proved to be malignant, a higher figure than other workers have previously been described.