Multidisipliner Toraks Konseyinde Değerlendirilen Pulmoner Nodüllerin İzlem Sonuçları, Malignite Oranları ve Malignite Belirleyicileri

Abstract

Solitary pulmonary nodules are defined as radiological parenchymal lesion that are smaller than 3 cm in diameter in the lung. Approach should be multidisciplinary. The results of the patients with pulmonary nodules who were discussed at Thoracic Oncology Board was weekly held with participation of departments of Chest Diseases, Cardiovascular and Thoracic Surgery, Radiology, Radiation Oncology, Medical Oncology, Patology, Nuclear Medicine of Hacettepe University Faculty of Medicine, Adult Hospital between the dates June 2003 - February 2013 were evaluated. 1000 Thoracic Oncology Board reports were screened. A total of 94 patients, 58 patients with solitary pulmonary nodules and 36 patients with multiple nodules, were recorded. According to the Thoracic Oncology Board reports of 58 patients with solitary pulmonary nodule, 30 patients were diagnosed by surgery and 10 patients were diagnosed by transthoracic biopsy .The remaining 18 patients had been followed up by decision of the Thoracic Oncology Board. Also 9 of 36 patients with multiple nodules were diagnosed by surgery, 4 patients by transthoracic biopsy and 23 were followed. 40% of SPN were determined as malignant. 1 of 18 patients with SPN were determined as a malignant during the follow-up. Thoracic Oncology Board malignancy detection success rate is 60% for patients with SPN who had biopsy sample. Thoracic Oncology Board malignancy detection success rate is 92.3% for patients with MPN who had biopsy sample. According to this study, the presence of additional malignancy, nodules with irregular edges are significantly associated with increased risk of malignancy (p <0.001 and 0.008). In this study, the patients who were selected for biopsy were younger, had larger nodule sizes and had more additional malignancy rate than the patients who were followed up. When follow-up patients are included, minimum accuracy rate of Thoracic Oncology Board for patients with solitary pulmonary nodule is 55.1% and for patients with multiple pulmonary nodules is 55.5%. Research priorities include developing and validating risk assessment models to estimate the probability of cancer among individuals with small nodules or subsolid nodules, performing studies that compare the benefits and harms of alternative management strategies among individuals stratified by cancer risk, determining the safety of CT scan surveillance by examining outcomes among individuals who choose this strategy, and developing and validating novel noninvasive biomarkers to facilitate diagnosis and determine prognosis