CT of the Solitary Pulmonary Nodule

Abstract

The management of a patient over the age of 40 years with a solitary pulmonary nodule (SPN) detected by plain chest roentgenography has been a source of concern for more than 3 decades [1–6]. Excision of an SPN, including resection of the involved lobe, became a feasible technique in the early 1950s. As data on such cases accumulated it became apparent that a significant percentage of innocent-appearing peripheral pulmonary nodular lesions actually represented lung cancers [1]. The prevailing philosophy regarding such lesions is that tissue diagnosis (occasionally by needle biopsy but more frequently by thoracotomy) is mandatory in order to exclude the possibility of a malignant lesion. We summarized the results of the five largest reported series of thoracotomies for SPNs and noted that most resected lesions were actually benign [1–6]. In almost every case in which thoracotomy was carried out for a benign lesion, the operation would have been unnecessary if the nature of the lesion could have been determined by noninvasive methods. The need for surgery was indeed a reflection of the inadequacy of diagnosis techniques.