smc ts management of cilm management of centrally located indeterminate lung mass
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SMC TSSMC TS
MANAGEMENT OF CILMMANAGEMENT OF CILM
Management of Management of Centrally Located Centrally Located
Indeterminate Lung MassIndeterminate Lung Mass
MANAGEMENT OF CILMMANAGEMENT OF CILM
SMC TSSMC TS
Definition of Centrally Definition of Centrally Located Indeterminate Located Indeterminate Lung Mass(CILM)Lung Mass(CILM)
Lung mass Lung mass located located in inner 2/3 in inner 2/3 of lung fieldof lung field
• Radiologically Radiologically - highly suspicious of malignancy - highly suspicious of malignancy
• Pathologically(bronchoscopy and PCNA) Pathologically(bronchoscopy and PCNA) - undiagnosed- undiagnosed- hard to approach by thoracoscopy- hard to approach by thoracoscopy
MANAGEMENT OF CILMMANAGEMENT OF CILM
SMC TSSMC TS
Patients and MethodsPatients and Methods
•Retrospective study of 24 pts Retrospective study of 24 pts out of 117 pts indeterminate lung out of 117 pts indeterminate lung massmass
•Period : July 1995 ~ February 2002Period : July 1995 ~ February 2002
•Age : 36 ~ 68 years(mean 57.7 Age : 36 ~ 68 years(mean 57.7 years)years)
•Male : 18 pts, Female : 4 ptsMale : 18 pts, Female : 4 pts
MANAGEMENT OF CILMMANAGEMENT OF CILM
SMC TSSMC TS
Diagnostic ProceduresDiagnostic Procedures1. Computed tomography in all patients1. Computed tomography in all patients2. Bronchoscopy :2. Bronchoscopy :
- Bronchial washing cytology : all patients - Bronchial washing cytology : all patients - Transbronchial lung biopsy : 1 pt - Transbronchial lung biopsy : 1 pt - Endobronchial biopsy : 5 pts- Endobronchial biopsy : 5 pts
3. Percutaneous Needle Aspiration Biopsy(PCNA) : 13 pts3. Percutaneous Needle Aspiration Biopsy(PCNA) : 13 ptsUndiagnosed & hard to approach by VATSUndiagnosed & hard to approach by VATSThoracotomyThoracotomy1)1) Lobectomy : 15 Lobectomy : 15 2)2) Segmentectomy : 1Segmentectomy : 13)3) Wedge resection : 8Wedge resection : 8 LN enlargement on CT : 4 ptsLN enlargement on CT : 4 pts - Mediastinoscopy and Thoracotomy were performed- Mediastinoscopy and Thoracotomy were performed
MANAGEMENT OF CILMMANAGEMENT OF CILM
SMC TSSMC TS
Pathologic ResultsPathologic Results
• MalignancyMalignancy 1 1 (4.(4.2%)2%)
• BenignBenign 2323• Tbc. granulomaTbc. granuloma 9 9• HamartomaHamartoma 6 6• Organizing pneumoniaOrganizing pneumonia 5 5• OthersOthers 3 3
MANAGEMENT OF CILMMANAGEMENT OF CILM
SMC TSSMC TS
ConclusionsConclusions• Malignancy should be ruled out in CILM, but, Malignancy should be ruled out in CILM, but, the the
incidence of pathological malignancy was lowincidence of pathological malignancy was low in in many cases of highly suspicious of malignancy omany cases of highly suspicious of malignancy on CT findings.n CT findings.
• The incidence of tuberculosis is high in this counThe incidence of tuberculosis is high in this country, therefore try, therefore “Wait & Watch” policy“Wait & Watch” policy can be one of can be one of the options in management of CILM.the options in management of CILM.
• CILM still requires more strict CT criteria, close pCILM still requires more strict CT criteria, close periodic follow-up and other diagnostic modailties eriodic follow-up and other diagnostic modailties such as PET.such as PET.
MANAGEMENT OF CILMMANAGEMENT OF CILM
SMC TSSMC TS
Management of Management of Centrally Located Centrally Located Indeterminate Indeterminate Lung Mass 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 ShimYoung Mog Shim
Department of Thoracic and Cardiovascular SurgeryDepartment of Thoracic and Cardiovascular Surgery Samsung Seoul Hospital Samsung Seoul Hospital School of Medicine Sungkyunkwan UniversitySchool of Medicine Sungkyunkwan University
Definition of Centrally Located IndDefinition of Centrally Located Indeterminate Lung Mass(CILM)eterminate Lung Mass(CILM)
Lung mass Lung mass located located in inner 2/3 in inner 2/3 of lung fieldof lung field
Radiologically Radiologically - highly suspicious of malignancy - highly suspicious of malignancy Pathologically(bronchoscopy and PCNA) Pathologically(bronchoscopy and PCNA) - undiagnosed- undiagnosed- hard to approach by thoracoscopy- hard to approach by thoracoscopy
Patients and Patients and MethodsMethodsRetrospective study of 24 pts Retrospective study of 24 pts
out of 117 pts indeter out of 117 pts indeterminate lung massminate lung massPeriod : July 1995 ~ February 2002Period : July 1995 ~ February 2002Age : 36 ~ 68 years(mean 57.7 years)Age : 36 ~ 68 years(mean 57.7 years)Male : 18 pts, Female : 4 ptsMale : 18 pts, Female : 4 pts
Diagnostic ProceduresDiagnostic Procedures
11. Computed tomography in all patients. Computed tomography in all patients2. Bronchoscopy :2. Bronchoscopy :
- Bronchial washing cytology : all patients - Bronchial washing cytology : all patients - Transbronchial lung biopsy : 1 pt - Transbronchial lung biopsy : 1 pt - Endobronchial biopsy : 5 pts- Endobronchial biopsy : 5 pts
3. Percutaneous Needle Aspiration Biopsy(PCNA) : 13 pts3. Percutaneous Needle Aspiration Biopsy(PCNA) : 13 ptsUndiagnosed & hard to approach by VATSThoracotomyUndiagnosed & hard to approach by VATSThoracotomy
Lobectomy : 15 Lobectomy : 15 Segmentectomy : 1Segmentectomy : 1Wedge resection : 8Wedge resection : 8LN enlargement on CT : 4 pts - MediLN enlargement on CT : 4 pts - Medi
astinoscopy and Thoracotomy were performedastinoscopy and Thoracotomy were performed
Pathologic ResultsPathologic Results
MalignancyMalignancy 1 1 (4.2%)(4.2%)BenignBenign 2323
Tbc. granulomaTbc. granuloma 9 9
HamartomaHamartoma 6 6
Organizing pneumoniaOrganizing pneumonia 5 5 OthersOthers
3 3ConclusionsConclusions- Malignancy should be ruled out in CILM, but, - Malignancy should be ruled out in CILM, but, the incithe incidence of pathological malignancy was lowdence of pathological malignancy was low in many cas in many cases of highly suspicious of malignancy on CT findings.es of highly suspicious of malignancy on CT findings.- The incidence of tuberculosis is high in this country, t- The incidence of tuberculosis is high in this country, therefore herefore “Wait & Watch” policy“Wait & Watch” policy can be one of the optio can be one of the options in management of CILM.ns in management of CILM.- CILM still requires more strict CT criteria, close perio- CILM still requires more strict CT criteria, close periodic follow-up and other diagnostic modailties such as dic follow-up and other diagnostic modailties such as PET.PET.