SMC TS MANAGEMENT OF CILM Management of Centrally Located Indeterminate Lung Mass.

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SMC TS MANAGEMENT OF CILM Management of Centrally Located Indeterminate Lung Mass

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

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

MANAGEMENT OF CILM SMC TS 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 1)Lobectomy : 15 2)Segmentectomy : 1 3)Wedge resection : 8  LN enlargement on CT : 4 pts - Mediastinoscopy and Thoracotomy were performed - Mediastinoscopy and Thoracotomy were performed

MANAGEMENT OF CILM SMC TS Pathologic Results Malignancy 1 (4.2%) Malignancy 1 (4.2%) Benign23 Benign23 Tbc. granuloma 9 Tbc. granuloma 9 Hamartoma 6 Hamartoma 6 Organizing pneumonia 5 Organizing pneumonia 5 Others 3 Others 3

MANAGEMENT OF CILM SMC TS 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. 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. 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. CILM still requires more strict CT criteria, close periodic follow-up and other diagnostic modailties such as PET.

MANAGEMENT OF CILM SMC TS Management of Centrally Located Indeterminate Lung Mass Jeong Woo Yoo, Sung Chul Kim, Hyung Soo Kim, Jeong Woo Yoo, Sung Chul Kim, Hyung Soo Kim, Yong Soo Choi, Kwanmin Kim, Jhingook Kim, Yong Soo Choi, Kwanmin Kim, Jhingook Kim, Young Mog Shim Young Mog Shim Department of Thoracic and Cardiovascular Surgery Department of Thoracic and Cardiovascular Surgery Samsung Seoul Hospital Samsung Seoul Hospital School of Medicine Sungkyunkwan University 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 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 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 Pathologic Results Malignancy 1 (4.2%) Benign23 Tbc. granuloma 9 Tbc. granuloma 9 Hamartoma 6 Hamartoma 6 Organizing pneumonia 5 Organizing pneumonia 5 Others 3 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.