Needle-localized thoracoscopic resection of indeterminate pulmonary nodules: Impact on management of patients with malignant disease

Background: The efficacy and therapeutic impact of needle-localized thoracoscopic resection (NLTR) was examined in patients with cancer who present with small indeterminate pulmonary nodules (IPNs). Methods: Between December 1991 and August 1992, 30 patients underwent needle localization of 33 IPNs under computed tomography (CT) guidance followed by thoracoscopic resection. All previous attempts to characterize these small pulmonary nodules (mean size 7.9 ± 4.9 mm) had failed. Twenty patients had an established diagnosis of cancer 1 month to 20 years before detection of the lung abnormality, whereas the remaining patients had no prior history of cancer. Results: Histology of NLTR specimens in patients with a previous diagnosis of malignancy included 13 malignant and seven benign lesions. In all patients with cancer, therapeutic decisions were influenced by NLTR results. Thoracoscopic related complications were noted in two patients. Average length of hospital stay for NLTR was 6.7 ± 3.9 days. Conclusion: NLTR in this series has proven to be a safe, well-tolerated, and accurate method for diagnosing and influencing the management of recently identified IPN. NLTR appears warranted for small pulmonary nodules not amenable to less invasive diagnostic modalities.