Unit:
Κατεύθυνση Καρκίνος Πνεύμονα: Σύγχρονη Κλινικοεργαστηριακή Προσέγγιση και ΈρευναLibrary of the School of Health Sciences
Author:
Athanasopoulou Angeliki
Supervisors info:
Κωνσταντίνος Συρίγος, Καθηγητής, Ιατρική, ΕΚΠΑ, Επιβλέπων
Μπακάκος Πέτρος, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ
Γαρυφαλλιά Πουλάκου, Επίκουρη Καθηγήτρια, Ιατρική, ΕΚΠΑ
Original Title:
Αλγόριθμος διερεύνησης μονήρη πνευμονικού όζου και εφαρμογή του από πνευμονολόγους σε τριτοβάθμιο νοσοκομείο κέντρο αναφοράς νοσημάτων θώρακος
Translated title:
Solitary pulmonary nodule investigation algorithm and its application by pulmonologists at a tertiary hospital chest disease reference center.
Summary:
INTRODUCTION: Investigating and treating patients with Solitary Pulmonary Nodules (SPN) is a common yet complicated clinical problem. The goal is the early diagnosis and treatment of all malignant nodes. The purpose of this study is to review the characteristics of the nodules, but also of the patients and assess the diagnostic strategy of pulmonologists in a thoracic reference center.
METHOD: After reviewing the international literature, we decided to carry out a retrospective study in patients with SPN from January 2017 to September 2018. Data were collected from medical records of pulmonology clinics and regular outpatient clinics, archives of the thoracic surgery department of our hospital and archives of histological reports. We compiled a total of 64 SPN cases, we thoroughly studied the clinical characteristics of the patients in conjunction with the nodal imaging characteristics, we separately evaluated the probability of malignancy, divided the patients into 8 groups, and then we compared the method of management by pulmonologists regarding diagnosis, with the method recommended by the guidelines .
RESULTS: We observe a tendency by pulmonologists to monitor all solitary pulmonary nodules irrespective of size, density and likelihood of malignancy, and a tendency for a reassessment to be made earlier than the time recommended by guidelines.
We also observe the use of PET / CT in solid nodules > 8 mm of very low (50%) and high (80%) probability of malignancy,which are groups of patients with no indication for this test.
Conventional bronchoscopy was performed in 81% of patients with an SPN of > 8 mm with intermediate and high probability of malignancy, even though this procedure is not included in the guidelines.
In the cases of SPN monitored by computed tomography, CT was performed with a Low Dose protocol in the majority of cases and in accordance with the guidelines.
15% of patients did not go for reassessment.
CONCLUSIONS: From our study, one could distinguish a more "aggressive" approach to investigation of SPN on the part of caregivers, who seem to be more concerned with the early diagnosis of a possible malignancy, than with the possible submission of patients to unnecessary tests-interventions. However, it should be noted that out of all patients with SPN (64 patients), malignancy was diagnosed at 42, without metastatic lymph node infiltration or infiltration of N1 stations to 98%, confirming the value of the SPN investigation algorithm in early diagnosis and treatment of the malignant nodules.
Main subject category:
Health Sciences
Keywords:
Αlgorithm, Solitary pulmonary nodule
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Athanasopoulou Aggeliki Master.pdf
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