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Vol. 156. Issue 11.
Pages 535-540 (June 2021)
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Vol. 156. Issue 11.
Pages 535-540 (June 2021)
Original article
Analysis of solitary pulmonary nodule after surgical resection in patients with 18F-FDG positron emission tomography integrated computed tomography in the preoperative work-up
Análisis del nódulo pulmonar solitario tras su resección quirúrgica en pacientes con 18F-FDG PET-TC integrado en el estudio preoperatorio
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Antonio Francisco Honguero Martíneza,
Corresponding author
tonyhonguero@yahoo.es

Corresponding author.
, Raúl Godoy Mayoralb, Marta Genovés Crespoa, Cora Andrea Sampedro Salinasa, Fernando Andrés Petrelc, Ana García Vicented, Patricia López Miguelb, Javier Callejas Gonzálezb, Carlos Eduardo Almonte Garcíaa, María Peyró Sáncheza, Ana María del Rosario Núñez Aresb, María Dolores García Jiméneza, Claudia Rossana Rodríguez Ortegaa, Marta Lázaro Sahuquilloa, Jesús Jiménez Lópezb, Pablo León Atancea, María Luisa Morales Serranoa
a Servicio de Cirugía Torácica, Hospital General Universitario de Albacete, Albacete, Spain
b Servicio de Neumología, Hospital General Universitario de Albacete, Albacete, Spain
c Unidad de Investigación, Hospital General Universitario de Albacete, Albacete, Spain
d Servicio de Medicina Nuclear, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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Figures (1)
Tables (4)
Table 1. Clinicopathological characteristics of patients operated on for SPN.
Table 2. Distribution according to the results of the PET-CT and the anatomical pathology.
Table 3. Statistically significant variables (P < .05) in the backward stepwise binary logistic regression analysis.
Table 4. Characteristics of PET-CT false positives and false negatives.
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Abstract
Introduction

To analyse clinicopathological characteristics of patients operated for pulmonary solitary nodule (PSN) and 18F-FDG integrated PET-CT scan after surgical resection.

Methodology

Retrospective study on a prospective database of patients operated from January 2007 to October 2017 for PSN without preoperative diagnosis. Dependent variable was anatomopathological result (benign vs malignant) of PSN. Variables of the study were: age, sex, PET-CT uptake, SUVmax, smoking history, COPD, previous history of malignant disease, tumoral location, and tumour size on CT-scan.

Results

A total of 305 patients were included in this study, 225 (73.8%) men, 80 (26.2%) women, mean age = 63.9 (range 29−86 years), mean size PSN = 1.68 (s.d. .65 cm), benign = 46 (15.1%), malignant = 258 (84.6%), type of resection: pulmonary wedge = 151 (49.5%), lobectomy = 141 (46.2%), segmentectomy = 12 (3.9%), exploratory intervention = 1 (0.3%). Postoperative mortality was 1.9%. COPD = 50.8% cases, previous cancer disease = 172 cases (56.4%), smoking history = 250 cases (82.0%), positive PET = 280 cases (91.8%), PSN in upper pulmonary fields = 204 cases (66.9%), median SUVmax = 3.4 (range 0−20.7). Backward stepwise binary logistic regression model showed that age, SUVmax, previous malignant disease and female sex were independent risk factors with statistical significance (P < .05). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 94.6%, 23.4%, 87.1%, 44.0%, and 83.6% respectively. There were 14 false negative cases (4.6%) and 36 false positive cases (11.8%).

Conclusions

Age, SUVmax, previous malignant disease, and female sex were independent risk factors in our study. Each case should be individually evaluated in a multidisciplinary committee, and the patient´s preferences or concerns should be kept in mind in decision-making. Surgical resection of PSN is not exempt frommorbidity and mortality, even in sublobar or pulmonary wedge resection.

Keywords:
Solitary pulmonary nodule
PET-TC scan
Lung cancer
Surgery
Resumen
Introducción

Analizar las características clinicopatológicas de los pacientes operados por nódulo pulmonar solitario (NPS) y 18F-FDG PET-TC integrado tras su resección quirúrgica.

Material y métodos

Estudio retrospectivo sobre una base de datos prospectiva de pacientes operados entre enero-2007 y octubre-2017 por NPS sin diagnóstico preoperatorio. La variable dependiente fue el resultado anatomopatológico (benigno vs maligno) del NPS. Las variables del estudio fueron: edad, sexo, captación en PET-TC, SUVmax, tabaquismo, EPOC, antecedente de tumoración maligna previa, localización del tumor y tamaño en la TC.

Resultados

Un total de 305 pacientes fueron incluidos en el estudio, 225 (73,8%) varones, 80 (26,2%) mujeres, edad media = 63,9 (rango 29–86 años), tamaño medio NPS = 1,68 (d.t. 0,65 cm), benignos = 46 (15,1%), malignos = 258 (84,6%), tipo de resección: cuña = 151 (49,5%), lobectomía = 141 (46,2%), segmentectomía = 12 (3,9%), exploradora = 1 (0,3%). La mortalidad postoperatoria fue del 1,9%. EPOC = 50,8% casos, cáncer previo = 172 casos (56,4%), tabaquismo = 250 casos(82%), PET positivo = 280 casos (91,8%), NPS en campos superiores = 204 casos (66,9%), SUVmax mediana = 3,4 (rango 0–20,7). El modelo de regresión logístina binaria por pasos hacia atrás mostró que la edad, SUVmax, enfermedad maligna previa y sexo femenino fueron factores de riesgo independientes con significación estadística (P < ,05).

La sensibilidad, especificidad, el valor predictivo positivo, el valor predictivo negativo y la seguridad diagnóstica fueron 94,6%, 23,4%, 87,1%, 44% y 83,6% respectivamente. Hubo un total de 14 casos falsos negativos (4,6%) y 36 casos falsos positivos (11,8%).

Conclusiones

La edad, el SUVmax, antecedentes de enfermedad maligna previa y sexo femenino fueron factores de riesgo independientes en nuestro estudio. Cada caso debe ser evaluado de forma individual en un Comité Multidisciplinar y atender a las inquietudes o preferencias de cada paciente. Hay que tener en cuenta que la opción quirúrgica no está exenta de morbi- mortalidad incluso en resecciones sublobares o en cuña.

Palabras clave:
Nódulo pulmonar solitario
PET-TC
Cáncer de pulmón
Cirugía

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