Thoracoscopic resection of solitary pulmonary nodules in patients with previous malignant tumors

Round opacities in the lungs found in the course of a neoplastic disorder or during the initial tumor staging are most often regarded as metastases without histological studies to prove their nature. These presumed metastases are, however, very often diagnosed later as benign lesions or primary malignant pulmonary tumors.

To investigate the histological substrate of solitary pulmonary nodules in patients with a history of neoplastic condition and study the role of video-assisted thoracoscopy in their diagnosing and treatment.

The study included 22 patients with solitary pulmonary nodules and history of previous malignant tumors who underwent video-assisted thoracoscopic surgery at the Clinic of Vascular and Thoracic Surgery, University Hospital Aschersleben, Germany between 01.01.2006 and 31.12.2009. Pulmonary wedge resection was performed and it was followed by histological verification.

A diagnosis of pulmonary metastasis was confirmed in only 8 of the patients (36.4%). In another 8 of them (36.4%) the solitary pulmonary nodule proved to be a primary lung cancer, i.e. a second malignant tumor. The bronchial carcinoma was synchronous with the primary tumor in four of these patients, and metachronous in the rest. In the other 6 patients (27.2%) the lesions proved to be benign.

Not all solitary pulmonary nodules in patients with preceding malignant formations are metastases. In order to define their nature more precisely they should be resected by video-assisted thoracoscopy, if possible. In benign lesions video-assisted thoracoscopic resection is the definitive medical procedure too.