Multiple pulmonary nodules with high metabolic activity: Potential benefit of multiple nodule biopsies by video‑assisted thoracic surgery: A case report

Wang,Jinlin; Li,Shiyue; Liu,Jun; Gu,Yingying; Chen,Ping

doi:10.3892/etm.2013.1180

Multiple pulmonary nodules with high metabolic activity: Potential benefit of multiple nodule biopsies by video‑assisted thoracic surgery: A case report

Authors:
- Jinlin Wang
- Shiyue Li
- Jun Liu
- Yingying Gu
- Ping Chen
View Affiliations

Affiliations: Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China, Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China, Department of Pathology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China, Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China
Published online on: June 25, 2013 https://doi.org/10.3892/etm.2013.1180
Pages: 325-328

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The aim of this study was to assess complex cases of multiple pulmonary nodules (PNs) with high metabolic activity that may have benefited from being managed in a manner outside the formal guidelines. The study describes the case of a patient with multiple highly metabolically‑active PNs, where an original diagnosis of lung cancer metastasis was proposed. Following a failed transbronchial lung biopsy (TBLB), multiple nodule biopsies by video‑assisted thoracic surgery (VATS) were performed, and a diagnosis of lymphoepithelioma‑like carcinoma (LELC; stage ⅠA) and tuberculosis was reached. This case report demonstrated that multiple nodule biopsies by VATS were effective and were able to improve the prognosis without delay.

View Figures

View References

1.	Ost D, Fein AM and Feinsilver SH: Clinical practice. The solitary pulmonary nodule. N Engl J Med. 348:2535–2542. 2003. View Article : Google Scholar : PubMed/NCBI
2.	Winer-Muram HT: The solitary pulmonary nodule. Radiology. 239:34–49. 2006. View Article : Google Scholar : PubMed/NCBI
3.	Herder GJ, Golding RP, Hoekstra OS, Comans EF, Teule GJ, Postmus PE and Smit EF: The performance of ¹⁸F-fluorodeoxyglucosepositron emission tomography in small solitary pulmonary nodules. Eur J Nucl Med Mol Imaging. 31:1231–1236. 2004.
4.	Fischer BM, Mortensen J, Langer SW, Loft A, Berthelsen AK, Daugaard G, Lassen U and Hansen HH: PET/CT imaging in response evaluation of patients with small cell lung cancer. Lung Cancer. 54:41–49. 2006. View Article : Google Scholar : PubMed/NCBI
5.	Wahidi MM, Govert JA, Goudar RK, Gould MK and McCrory DC; American College of Chest Physicians: Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 132(Suppl): 94S–107S. 2007. View Article : Google Scholar
6.	Rivera MP and Mehta AC; American College of Chest Physicians: Initial diagnosis of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 132(Suppl): 131S–148S. 2007. View Article : Google Scholar : PubMed/NCBI
7.	Cardillo G, Regal M, Sera F, Di Martino M, Carbone L, Facciolo F and Martelli M: Videothoracoscopic management of the solitary pulmonary nodule: a single-institution study on 429 cases. Ann Thorac Surg. 75:1607–1612. 2003. View Article : Google Scholar : PubMed/NCBI
8.	Li Y, Su M, Li F, Kuang A and Tian R: The value of ¹⁸F-FDG-PET/CT in the differential diagnosis of solitary pulmonary nodules in areas with a high incidence of tuberculosis. Ann Nucl Med. 25:804–811. 2011.
9.	Gould MK, Fletcher J, Iannettoni MD, Lynch WR, Midthun DE, Naidich DP and Ost DE; American College of Chest Physicians: Evaluation of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 132(Suppl): 108S–130S. 2007. View Article : Google Scholar
10.	Higashi K, Ueda Y, Seki H, Yuasa K, Oguchi M, Noguchi T, et al: Fluorine-18-FDG PET imaging is negative in bronchioloalveolar lung carcinoma. J Nucl Med. 39:1016–1020. 1998.PubMed/NCBI
11.	Lowe VJ, Fletcher JW, Gobar L, Lawson M, Kirchner P, Valk P, Karis J, Hubner K, Delbeke D, et al: Prospective investigation of positron emission tomography in lung nodules. J Clin Oncol. 16:1075–1084. 1998.PubMed/NCBI
12.	Shinagare AB, Cunto-Amesty G and Fennessy FM: Multiple inflammatory nodules: a differential diagnosis of new pulmonary nodules in oncology patients. Cancer Imaging. 10:205–208. 2011. View Article : Google Scholar : PubMed/NCBI
13.	Hodnett PA and Ko JP: Evaluation and management of indeterminate pulmonary nodules. Radiol Clin North Am. 50:895–914. 2012. View Article : Google Scholar
14.	Oki M, Saka H, Kitagawa C, Kogure Y, Murata N, Adachi T and Ando M: Randomized study of endobronchial ultrasound-guided transbronchial biopsy: thin bronchoscopic method versus guide sheath method. J Thorac Oncol. 7:535–541. 2012. View Article : Google Scholar
15.	Lamprecht B, Porsch P, Wegleitner B, Strasser G, Kaiser B and Studnicka M: Electromagnetic navigation bronchoscopy (ENB): Increasing diagnostic yield. Respir Med. 106:710–715. 2012. View Article : Google Scholar : PubMed/NCBI
16.	Klein JS and Zarka MA: Transthoracic needle biopsy. Radiol Clin North Am. 38:235–266. 2000. View Article : Google Scholar
17.	Klein JS, Salomon G and Stewart EA: Transthoracic needle biopsy with a coaxially placed 20-gauge automated cutting needle: results in 122 patients. Radiology. 198:715–720. 1996. View Article : Google Scholar : PubMed/NCBI
18.	Prisadov GC, Wallimann H and Welcker K: Our experience in the diagnostics and therapy of patients with solitary peripheral lung tumours. Folia Med (Plovdiv). 53:47–52. 2011.PubMed/NCBI
19.	Dong Q, Liang L, Li Y, Liu J, Yin W, Chen H, et al: Anesthesia with nontracheal intubation in thoracic surgery. J Thorac Dis. 4:126–130. 2012.PubMed/NCBI
20.	Chen YR, Yeow KM, Lee JY, Su IH, Chu SY, Lee CH, et al: CT-guided hook wire localization of subpleural lung lesions for video-assisted thoracoscopic surgery (VATS). J Formos Med Assoc. 106:911–918. 2007. View Article : Google Scholar : PubMed/NCBI