Định vị nốt phổi trước phẫu thuật bằng Hookwire, phương cách tiếp cận chẩn đoán và điều trị ung thư phổi sớm – Tổng quan tài liệu và báo cáo chùm ca bệnh.

Abstract

In clinical practice of respiratory diseases, we often encounter solitary pulmonary nodules (SPN). SPNs  have 3 main forms: (1) Solid nodules (SN); (2) Part-solid nodules (PS); (3) Ground glass opacity (GGO); (4) Cyst nodules (CN). There have been many guidelines from different societies/society around the world on the management of SPN (NCCN; Fleischner; ATS; ERS...). However, these instructions are general in nature and do not address the issue of individualization.

To be able to treat/cure lung cancer well, early detection and choosing appropriate treatment methods play a decisive role. Association guidelines are based on size, structure and risk factors to devise a management strategy for solitary nodules, which factors in nodule size at first detection as well as subsequent screenings plays a key role. According to NCCN: (1) SN, ≥ 8mm to > 15 mm in subjects at high risk of lung cancer should be monitoring by LDCT every 3 months or PET scan; Nodules ≥ 15 mm should have a contrast CT scan/PET scan/tissue sampling. If the results indicate high suspicion of LC, the biopsy/nodular excision is indicated; (2) PS nodules when the solid part is ≥ 8mm, at high risk subjects can be applied above techniques; (3) GGO < 20 mm, monitoring by LDCT once a year; > 20 mm every 6 months, no recommendation for biopsy or resection. Thus, if this recommendation is applied correctly, there will be many cancerous nodules under the above sizes that will be "nourished" until they meet treatment standards, which will inevitably reduce the chance of being diagnoses and early treatment, losing the opportunity to "cure" the patient. Another common situation: A single nodule/mass on one side of the lung is still amenable to surgery, but another single nodule appears in the same lung on the same side but in a different lobe or on the opposite lung. So, very important to confirm the nodule is secondary/non-secondary before lobectomy containing the primary lesion. In this situation, according to our knowledge, there is no  any guideline to recomendation.

We report 22 cases in which lung nodules were located before thoracoscopic surgery (VAST) using Hookwire, many of which were assigned an "individualized" approach (not recommendation) and gave surprising results. Discussion is based on analysis of image characteristics and pathological results and recommends the idea of "individualizing" each case for colleagues to refer to.