The solitary pulmonary nodule: Aggressive excisional strategy

Treatment of cancer at an early stage leads to enhanced survival. Low-dose spiral computed tomography (CT) scanning is readily available and allows early detection of solitary pulmonary nodules. Thoracic surgeons should embrace a calculated yet aggressive approach to early definitive diagnosis of solitary pulmonary nodules. Sputum cytology, bronchoscopy and biopsy, image-guided fine-needle aspiration cytology, and positron emission tomography with ¹⁸fluorodeoxyglucose (FDG-PET) scanning are useful diagnostic tools, but problems unique to each and the possibility of false-negative examination have relegated their use to selected nodules. Serial radiographic examination remains the main noninvasive test for diagnosis of solitary pulmonary nodules. Video-thoracic surgery allows resection of pulmonary nodules with minimal morbidity and mortality. Today, diagnosis by excisional biopsy is an acceptable management strategy as more and smaller nodules are being detected but not diagnosed. In 2002, when in doubt, we should take out the solitary pulmonary nodule.