Surgical Resection of Benign Nodules in Lung Cancer Screening: Incidence and Features
Introduction: Interventions and surgical procedures are common for nonmalignant lung lesions detected on lung cancer screening (LCS). Inadvertent surgical resection of benign nodules with a clinical suspicion of lung cancer can occur, can be associated with complications, and adds to the cost of scr...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-12-01
|
| Series: | JTO Clinical and Research Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666364323001480 |
| _version_ | 1797383688993898496 |
|---|---|
| author | John M. Archer, MD Dexter P. Mendoza, MD Yin P. Hung, MD, PhD Michael Lanuti, MD Subba R. Digumarthy, MD |
| author_facet | John M. Archer, MD Dexter P. Mendoza, MD Yin P. Hung, MD, PhD Michael Lanuti, MD Subba R. Digumarthy, MD |
| author_sort | John M. Archer, MD |
| collection | DOAJ |
| description | Introduction: Interventions and surgical procedures are common for nonmalignant lung lesions detected on lung cancer screening (LCS). Inadvertent surgical resection of benign nodules with a clinical suspicion of lung cancer can occur, can be associated with complications, and adds to the cost of screening. The objective of this study is to assess the characteristics of surgically resected benign nodules detected on LCS computed tomography which were presumed to be lung cancers. Methods: This retrospective study included 4798 patients who underwent LCS between June 2014 and January 2021. The benign lung nodules, surgically resected with a presumed cancer diagnosis, were identified from the LCS registry. Patient demographics, imaging characteristics, and pathologic diagnoses of benign nodules were analyzed. Results: Of the 4798 patients who underwent LCS, 148 (3.1%) underwent surgical resection of a lung nodule, and of those who had a resection, 19 of 148 (12.8%) had a benign diagnosis (median age = 64 y, range: 56–77 y; F = 12 of 19, 63.2%; M = seven of 19, 36.8%). The median nodule size was 10 mm (range: 6–31 mm). Most nodules were solid (15 of 19, 78.9%), located in the upper lobes (11 of 19; 57.9%), and were peripheral (17 of 19, 89.5%). Most nodules (13 of 17; 76.5%) had interval growth, and four of 17 (23.5%) had increased fluorodeoxyglucose uptake. Of the 19 patients, 17 (89.5%) underwent sublobar resection (16 wedge resection and one segmentectomy), whereas two central nodules (10.5%) had lobectomies. Pathologies identified included focal areas of fibrosis or scarring (n = 8), necrotizing granulomatous inflammation (n = 3), other nonspecific inflammatory focus (n = 3), benign tumors (n = 3), reactive lymphoid hyperplasia (n = 1), and organizing pneumonia (n = 1). Conclusions: Surgical resections of benign nodules that were presumed malignant are infrequent and may be unavoidable given overlapping imaging features of benign and malignant nodules. Knowledge of benign pathologies that can mimic malignancy may help reduce the incidence of unnecessary surgeries. |
| first_indexed | 2024-03-08T21:24:40Z |
| format | Article |
| id | doaj.art-e44e02c963ed4a2295b65d80838b1059 |
| institution | Directory Open Access Journal |
| issn | 2666-3643 |
| language | English |
| last_indexed | 2024-03-08T21:24:40Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTO Clinical and Research Reports |
| spelling | doaj.art-e44e02c963ed4a2295b65d80838b10592023-12-21T07:37:26ZengElsevierJTO Clinical and Research Reports2666-36432023-12-01412100605Surgical Resection of Benign Nodules in Lung Cancer Screening: Incidence and FeaturesJohn M. Archer, MD0Dexter P. Mendoza, MD1Yin P. Hung, MD, PhD2Michael Lanuti, MD3Subba R. Digumarthy, MD4Department of Radiology, Massachusetts General Hospital, Boston, MassachusettsDepartment of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New YorkDepartment of Pathology, Massachusetts General Hospital, Boston, MassachusettsDepartment of Surgery, Massachusetts General Hospital, Boston, MassachusettsDepartment of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Corresponding author. Address for correspondence: Subba Digumarthy, MD, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Founders 202, Boston, MA 02114.Introduction: Interventions and surgical procedures are common for nonmalignant lung lesions detected on lung cancer screening (LCS). Inadvertent surgical resection of benign nodules with a clinical suspicion of lung cancer can occur, can be associated with complications, and adds to the cost of screening. The objective of this study is to assess the characteristics of surgically resected benign nodules detected on LCS computed tomography which were presumed to be lung cancers. Methods: This retrospective study included 4798 patients who underwent LCS between June 2014 and January 2021. The benign lung nodules, surgically resected with a presumed cancer diagnosis, were identified from the LCS registry. Patient demographics, imaging characteristics, and pathologic diagnoses of benign nodules were analyzed. Results: Of the 4798 patients who underwent LCS, 148 (3.1%) underwent surgical resection of a lung nodule, and of those who had a resection, 19 of 148 (12.8%) had a benign diagnosis (median age = 64 y, range: 56–77 y; F = 12 of 19, 63.2%; M = seven of 19, 36.8%). The median nodule size was 10 mm (range: 6–31 mm). Most nodules were solid (15 of 19, 78.9%), located in the upper lobes (11 of 19; 57.9%), and were peripheral (17 of 19, 89.5%). Most nodules (13 of 17; 76.5%) had interval growth, and four of 17 (23.5%) had increased fluorodeoxyglucose uptake. Of the 19 patients, 17 (89.5%) underwent sublobar resection (16 wedge resection and one segmentectomy), whereas two central nodules (10.5%) had lobectomies. Pathologies identified included focal areas of fibrosis or scarring (n = 8), necrotizing granulomatous inflammation (n = 3), other nonspecific inflammatory focus (n = 3), benign tumors (n = 3), reactive lymphoid hyperplasia (n = 1), and organizing pneumonia (n = 1). Conclusions: Surgical resections of benign nodules that were presumed malignant are infrequent and may be unavoidable given overlapping imaging features of benign and malignant nodules. Knowledge of benign pathologies that can mimic malignancy may help reduce the incidence of unnecessary surgeries.http://www.sciencedirect.com/science/article/pii/S2666364323001480Lung cancer screeningChest CTRadiologyThoracic surgery |
| spellingShingle | John M. Archer, MD Dexter P. Mendoza, MD Yin P. Hung, MD, PhD Michael Lanuti, MD Subba R. Digumarthy, MD Surgical Resection of Benign Nodules in Lung Cancer Screening: Incidence and Features JTO Clinical and Research Reports Lung cancer screening Chest CT Radiology Thoracic surgery |
| title | Surgical Resection of Benign Nodules in Lung Cancer Screening: Incidence and Features |
| title_full | Surgical Resection of Benign Nodules in Lung Cancer Screening: Incidence and Features |
| title_fullStr | Surgical Resection of Benign Nodules in Lung Cancer Screening: Incidence and Features |
| title_full_unstemmed | Surgical Resection of Benign Nodules in Lung Cancer Screening: Incidence and Features |
| title_short | Surgical Resection of Benign Nodules in Lung Cancer Screening: Incidence and Features |
| title_sort | surgical resection of benign nodules in lung cancer screening incidence and features |
| topic | Lung cancer screening Chest CT Radiology Thoracic surgery |
| url | http://www.sciencedirect.com/science/article/pii/S2666364323001480 |
| work_keys_str_mv | AT johnmarchermd surgicalresectionofbenignnodulesinlungcancerscreeningincidenceandfeatures AT dexterpmendozamd surgicalresectionofbenignnodulesinlungcancerscreeningincidenceandfeatures AT yinphungmdphd surgicalresectionofbenignnodulesinlungcancerscreeningincidenceandfeatures AT michaellanutimd surgicalresectionofbenignnodulesinlungcancerscreeningincidenceandfeatures AT subbardigumarthymd surgicalresectionofbenignnodulesinlungcancerscreeningincidenceandfeatures |