Need for Preoperative Diagnosis of Solitary Pulmonary Nodules

Argument in favor of fine needle aspiration biopsy to establish the diagnosis.

• What if it turns out to be SCC?
• What if it is a benign lesion?

Argument against fine needle aspiration biopsy as a routine preoperative measure.

• When there is clinical suspicions for lung cancer a positive or negative biopsy outcome will result in the same management option, ie. surgery.
• Even if it is SCC, the treatment option for this mode of presentation is surgery.
• There is a small risk for seeding of the tumor at the puncture site.

My Recommendation:

I do FNAB of solitary pulmonary nodule:

• Whenever there is a strong suspicion for inflammatory process.
• Patient has inoperable lesion, but requires a diagnosis.
• Lesion is inoperable because of other medical reasons, but requires diagnosis prior to alternate method of therapy, eg. RT.

With patients in whom the clinical suspicion for lung cancer is high and if he has an operable lesion, I send him straight for thoracotomy without a FNAB.

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