2008 Volume 22 Issue 7 Pages 992-996
Objective. In some cases of lung cancer, it is difficult to obtain a histological diagnosis with bronchoscopy or computed tomography (CT)-guided needle biopsy. In 1999, CT screening was started in our area, and the rate of detection of indeterminate lung nodules has increased. In practice, when CT findings are highly suggestive of lung cancer, resection is often performed without a histological diagnosis. In this study, indeterminate rates for total lung cancer related to resection were evaluated. Rates of benign disease for indeterminate cases were also evaluated. Methods. A retrospective study. A total of 1039 patients diagnosed with lung cancer or suspected lung cancer underwent resection between 1997 and 2005. In 516 patients, a histological diagnosis was not obtained preoperatively. CT screening was initiated in 1999 in our area. Indeterminate rates and reasons for the lack of a preoperative histological diagnosis were compared before and after the initiation of CT screening. The postoperative histology was reviewed, and the accuracy of the preoperative diagnosis was evaluated. Results. Before the initiation of CT screening, the indeterminate rate was approximately 28 %. After the initiation of CT screening, the indeterminate rate has increased to approximately 55 %, and the major reason for indeterminacy was that the tumor was too small for bronchoscopy or CT-guided needle biopsy. Of the 516 patients, postoperative histological examination demonstrated benign disease in 69 (13.4 %). The rate of benignity showed a decreasing tendency during the study period. Conclusion. The initiation of CT screening has increased the preoperative indeterminate rate. Some unnecessary resections for benign diseases were performed. However, the accuracy of diagnosis has improved due to change of our strategy for small nodules.
