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Management of Centrally Located Indeterminate Lung Mass

Management of Centrally Located Indeterminate Lung Mass. Definition of Centrally Located Indeterminate Lung Mass(CILM). Lung mass located in inner 2/3 of lung field. Radiologically - highly suspicious of malignancy Pathologically(bronchoscopy and PCNA) - undiagnosed

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Management of Centrally Located Indeterminate Lung Mass

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  1. Management of Centrally Located Indeterminate Lung Mass

  2. Definition of Centrally Located Indeterminate Lung Mass(CILM) Lung mass located in inner 2/3 of lung field • Radiologically • - highly suspicious of malignancy • Pathologically(bronchoscopy and PCNA) • - undiagnosed • - hard to approach by thoracoscopy

  3. Patients and Methods • Retrospective study of 24 pts out of 117 pts indeterminate lung mass • Period : July 1995 ~ February 2002 • Age : 36 ~ 68 years(mean 57.7 years) • Male : 18 pts, Female : 4 pts

  4. Diagnostic Procedures 1. Computed tomography in all patients 2. Bronchoscopy : - Bronchial washing cytology : all patients - Transbronchial lung biopsy : 1 pt - Endobronchial biopsy : 5 pts 3. Percutaneous Needle Aspiration Biopsy(PCNA) : 13 pts Undiagnosed & hard to approach by VATS Thoracotomy • Lobectomy : 15 • Segmentectomy : 1 • Wedge resection : 8 • LN enlargement on CT : 4 pts - Mediastinoscopy and Thoracotomy were performed

  5. Pathologic Results • Malignancy 1 (4.2%) • Benign 23 • Tbc. granuloma 9 • Hamartoma 6 • Organizing pneumonia 5 • Others 3

  6. Conclusions • Malignancy should be ruled out in CILM, but, the incidence of pathological malignancy was low in many cases of highly suspicious of malignancy on CT findings. • The incidence of tuberculosis is high in this country, therefore “Wait & Watch” policy can be one of the options in management of CILM. • CILM still requires more strict CT criteria, close periodic follow-up and other diagnostic modailties such as PET.

  7. Management of Centrally Located Indeterminate Lung Mass Diagnostic Procedures • 1. Computed tomography in all patients • 2. Bronchoscopy : • - Bronchial washing cytology : all patients • - Transbronchial lung biopsy : 1 pt • - Endobronchial biopsy : 5 pts • 3. Percutaneous Needle Aspiration Biopsy(PCNA) : 13 pts • Undiagnosed & hard to approach by VATSThoracotomy • Lobectomy : 15 • Segmentectomy : 1 • Wedge resection : 8 • LN enlargement on CT : 4 pts - Mediastinoscopy and Thoracotomy were performed Jeong Woo Yoo, Sung Chul Kim, Hyung Soo Kim, Yong Soo Choi, Kwanmin Kim, Jhingook Kim, Young Mog Shim Department of Thoracic and Cardiovascular Surgery Samsung Seoul Hospital School of Medicine Sungkyunkwan University Definition of Centrally Located Indeterminate Lung Mass(CILM) Lung mass located in inner 2/3 of lung field Radiologically - highly suspicious of malignancy Pathologically(bronchoscopy and PCNA) - undiagnosed - hard to approach by thoracoscopy Pathologic Results • Malignancy 1 (4.2%) • Benign 23 • Tbc. granuloma 9 • Hamartoma 6 • Organizing pneumonia 5 • Others 3 Conclusions - Malignancy should be ruled out in CILM, but, the incidence of pathological malignancy was low in many cases of highly suspicious of malignancy on CT findings. - The incidence of tuberculosis is high in this country, therefore “Wait & Watch” policy can be one of the options in management of CILM. - CILM still requires more strict CT criteria, close periodic follow-up and other diagnostic modailties such as PET. Patients and Methods Retrospective study of 24 pts out of 117 pts indeterminate lung mass Period : July 1995 ~ February 2002 Age : 36 ~ 68 years(mean 57.7 years) Male : 18 pts, Female : 4 pts

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