Evaluation and Surgical Treatment Strategies for Solitary Pulmonary Nodules

Background: The origin of solitary pulmonary nodules (SPN) is difficult to determine because they do not exhibit distinct imaging features; further, it is not easy to determine if the lesions are benign or malignant, which may lead to misdiagnosis and delayed treatment. Caution should be taken during intraoperative diagnosis and surgical treatment of SPN to avoid the use of invasive diagnosis methods and excessive treatment. In this study, we investigated the diagnosis and treatment strategies for patients with SPNs. Methods: The clinical data of 167 patients who underwent surgical removal of SPNs between January 2010 and December 2015 was collected for retrospective analysis. Results: Tumor removal was achieved by conventional incision or video-assisted small-incision surgery. Malignant lesions were confirmed in 69 patients (41.32%) by performing pathological examination after operation. Different degrees of hilus pulmonis and mediastinum lymph node metastases were observed in 11 patients. The preoperative diagnostic accordance rates and diagnostic specificity of chest computed tomography (CT), CT-guided percutaneous aspiration biopsy, and positron emission tomography (PET)/CT examinations were significant difference. The diagnostic accordance rates were 70.77%, 85.96%, and 91.67%, respectively (P=0.002), diagnostic sensitivities were 86.06%, 77.78%, 95.83%, respectively (P=0.165), diagnostic specificities were 68.18%, 100%, 87.50%, respectively (P=0.003). Conclusion: Preoperative chest CT, CT-guided percutaneous lung biopsy, and PET/CT examinations could be used for the diagnosis of SPNs. Surgical resection has both diagnostic and therapeutic implications for SPNs. Surgical treatment should be personalized according to the patient’s condition. Excessive or conservative surgery must be avoided as far as possible to avoid pathological misdiagnosis.