Clinical and radiological findings in relation to histopathological results of pulmonary nodule resections

Year 2025, Volume: 38 Issue: 2, 121 - 128, 30.05.2025

Shahab Ghivi Sehnaz Olgun , Caner Çınar , Cansu Yıldız Derya Kocakaya , Nezih Onur Ermerak Emine Bozkurtlar , Özlem Demircioğlu , Hüseyin Arıkan , Feyza Şen , Özlem Ercelep , Cagatay Çimşit , Emel Eryüksel , Sait Karakurt , Bedrettin Yıldızeli

https://izlik.org/JA34EE69CA

Abstract

Objective: Despite technological advances and well-defined clinical scoring, pulmonary nodule management still remains a
controversial issue. Due to conflicting situations, many patients are referred to reference centers for evaluation.
The aim of this study is to reveal the relationship between clinical, radiological, and histopathological findings of patients with
surgically resected pulmonary nodules who were followed-up by a multicisciplinary team at a 3rd level reference center.
Patients and Methods: Patients, who were followed-up by the multidisciplinary team and underwent surgical resection per the
multidisciplinary team’s recommendations between October, 2018 and December, 2021, were included in the study.
Results: A total 209 eligible patients were identified. 133 (63.6%) patients had solitary pulmonary nodules, 61 (29.3%) patients had
2-4 nodules and 15 (7.2%) patients had 5 nodules, 29 (13.9%) of patients had the largest nodule less than 1 cm diameter. According
to nodule nature, solid nodules were detected in 154 (73.7%), subsolid in 43 (25.6%) and ground glass in 12 (5.7%) patients and
malignant histopathology was detected in 107 (69.5%), 37 (86%) and in 8 (66.6%) respectively. Among twenty-nine (13.9%) patients
with subcentimetric nodules, 16 (61.5%) patients were diagnosed with malignancy. Thirty-three (15.8%) patients showed no avidity
in PET-CT scan of whom 4 (12.1%) were diagnosed with adenocarcinoma metastasis. Totally, 185 (88.5%) surgical procedures were
performed by video assisted thoracic surgery (VATS), 24 (11.5%) patients needed thoracotomy without mortality. Multivariate analysis
showed that previous malignancy history (p<0.019), diameter of a nodule (>1 cm) (p<0.027), emphysema in lung parenchyma
(p<0.003), high Brock risk score (p<0.011), high Herder risk score (p<0.001), increased avidity of PET scan (p<0.001) were risk factors
for malignancy.
Conclusion: Clinical scoring, radiological findings and patient history are important factors in the prediction of malignancy, but
multidisciplinary follow-up, especially, in conflicting cases plays a critical role in terms of detecting malignancy. VATS is a safe surgical
method that can be used for definitive diagnosis in these patients.

Keywords

Pulmonary nodule , Malignancy prediction , PET-CT , VATS

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