Small pulmonary lesions--a challenge for thoracic surgery?

Our plain-English summary of Small pulmonary lesions--a challenge for thoracic surgery?, by K. Kayser, D. Donnwald, S. Zink, et al (TheScientificWorldJournal, 2001).

The study

• Authors: K. Kayser, D. Donnwald, S. Zink, G. Kayser
• Journal: TheScientificWorldJournal
• Published: 2001;1:906-13
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We analyzed the diagnosis, the potentially associated external and clinical features, and the surgical procedures of small pulmonary lesions, especially hamartomas (in relation to peripheral T1 lung carcinomas and lymphoid hyperplasia) in 103 patients who experienced enucleation or resection of pulmonary hamartomas between March 1, 1995 and December 31, 2000. The causes of surgical intervention, presurgical diagnoses, surgical procedures, location, size, and histological compartments were analyzed, as well as clinical features potentially associated with the tumors (alcohol, asbestos, smoking, and chronic lung diseases). Follow up of patients lasted for 5.5 years at maximum. For comparison, 36 patients with peripheral T1 lung carcinomas are included as well as 50 patients with lymphoid hyperplasia. The sex and age distribution of the patients with hamartomas was comparable to that of patients with lymphoid hyperplasia. About 75% of men and 55% of women were heavy smokers, with an average history of 30 and 17 pack years, respectively. In 84% of patients, the lesions were incidentally detected in chest radiographs, whereas 12% of patients underwent thoracic surgery suspicious for intrapulmonary metastases of known extrapulmonary malignancies. Enucleation was performed in 21%, and wedge resection in 77% of patients. At average, hamartomas were smaller than T1 lung carcinomas, but considerably larger in comparison to lymphoid hyperplasia. No recurrent tumors or additionally detected hamartomas were noted during the follow up, and both surgical procedures (enucleation or wedge resection) were identical in curative treatment. All patients with peripherally localized T1 tumors underwent lobectomy. The 3/5 year survival rate was calculated to 69/52%. Lymphoid hyperplasia is of clinical importance for the estimation of prognosis in patients with metastatic disease, as the number of radiologically suggestive metastatic nodules can often be significantly changed due to this entity. Pulmonary hamartomas are benign lesions that display certain clinical associations with malignant lung carcinomas in respect to external risk factors, and to lymphoid hyperplasia. Both surgical procedures (enucleation or wedge resection) can be performed, giving identical results in respect to treatment.

In plain English

This prospective study from the Thoraxklinik in Heidelberg, Germany, looked at 103 patients who had benign lung growths called pulmonary hamartomas surgically removed between March 1995 and December 2000. For comparison, it included 36 patients with small peripheral lung carcinomas staged T1 N0 beforehand, 9 of whom (25%) proved to have lymph node metastases, and 50 patients with lymphoid hyperplasia. Asbestos was listed among the features examined, but no asbestos findings were reported. Among hamartoma patients, 75.4% of men and 54.8% of women were smokers, averaging 29.7 and 16.8 pack years. Most lesions (84%) were found by chance on chest X-rays. Wedge resection was used in 77% of hamartoma patients and enucleation in 21%. Hamartomas averaged 1.5 cm across. No recurrences were seen. Four hamartoma patients died during follow-up, all from lung metastases of cancers elsewhere in the body. The authors observed no association between survival and surgical technique. In the carcinoma group, survival was 69% at 3 years and 52% at 5 years. The authors concluded that hamartomas show certain clinical associations with lung carcinomas regarding external risk factors.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Prospective single-centre clinical study of surgically treated patients, with two comparison groups
• Who was studied: 103 patients (61 men, 42 women) with surgically excised pulmonary hamartomas at the Thoraxklinik, Heidelberg, Germany, March 1, 1995 to December 31, 2000. Comparison groups were 36 patients whose radiologically comparable lesions, staged T1 N0, proved to be primary lung carcinomas, and 50 patients with lymphoid hyperplasia.
• Exposure: Clinical features potentially associated with the lesions: alcohol, asbestos, smoking and chronic lung diseases. Smoking was reported in detail. No asbestos exposure data or results were reported.
• Main results:
  • In the hamartoma group, 75.4% of men and 54.8% of women were smokers, with an average of 29.7 pack years in men and 16.8 pack years in women
  • In 84% of hamartoma patients the lesions were found incidentally on chest radiographs. 12% had surgery because the lesions were suspected to be metastases of known cancers outside the lung.
  • Surgical procedures for hamartomas: wedge resection 77%, enucleation 21%, lobe resection 2%
  • Hamartomas measured on average 1.5 cm in diameter (2.3 cm3 volume)
  • No recurrent tumors or additional hamartomas were found during follow-up of the hamartoma patients
  • Four hamartoma patients died during the 72-month follow-up period, all from lung metastases of tumors outside the lung
  • In hamartoma patients, no association between survival and surgical technique was observed
  • In the T1 lung carcinoma group, staged T1 N0 before surgery, 9 of 36 patients (25%) already had lymph node metastases
  • Survival in the T1 lung carcinoma group was 69% at 3 years and 52% at 5 years
  • In the lymphoid hyperplasia group, 77 nodules were removed from 50 patients (1.5 nodules per patient)
• The authors' conclusion: The authors concluded that pulmonary hamartomas are benign lesions that show certain clinical associations with malignant lung carcinomas with respect to external risk factors, and with lymphoid hyperplasia. They also concluded that enucleation and wedge resection give identical treatment results.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Thoracic Surgery, Carcinoma, Chest X-Ray, Prognosis.

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