Presence of local pleural adhesion in CT screening-detected small nodule in the lung periphery suggests noncancerous, inflammatory nature of the lesion.

PURPOSE: Differential diagnosis of small nodules in the lung periphery detected by low-dose chest CT screening is important before surgery. The aim of the study was to discriminate between benign and malignant lesions, identified in our preoperative imaging work-up examinations and confirmed during surgery, for nodules detected on CT screening. MATERIALS AND METHODS: This study is based on 106 patients (46 men and 60 women, median age: 61.5 years) with 123 CT screening-detected and histologically confirmed nodules smaller than 30 mm in the lung periphery identified between 2002 and 2005 at Azumi General Hospital, Japan. Lesions were classified into three groups according to histological findings: adenocarcinoma, atypical adenomatous hyperplasia (AAH) and inflammatory focal lesions. We examined the visceral pleura during surgery at a location close to lung nodules. RESULTS: The median diameter of resected lung nodules on high-resolution CT (HRCT) was 9.0 mm. Nodules were nonsolid in 42, partly solid in 51 and solid in 30. Histopathological diagnosis was lung cancer in 69, AAH in 21, other noninflammatory tumours in 6 and inflammatory lesions in 27. Fifty-four lesions were located in the subpleural zone. Eight of 123 nodules showed local pleural adhesions (LPA), while 2 were buried in extensive pleural adhesion. LPA was noted more frequently in inflammatory nodules than in cancer nodules (P<.01). CONCLUSION: The presence of LPA in close proximity to a small nodule is indicative of noncancerous lesion. This feature allows the discrimination of pulmonary peripheral inflammatory lesion from peripheral small cancer on chest low-dose CT screening.

[An octogenarian case of postoperative recurrent lung cancer responding to treatments with radiation plus gefitinib].

An 82-year-old woman, a never smoker, had a radical operation for CT screening revealed lung cancer in an other hospital in 1997. She was admitted to our hospital complaining of dry cough and dyspnea on effort in March 2004. She was diagnosed to have a local recurrence of lung cancer 6 years after the operation. After she underwent radiotherapy of the mediastinum (total 60 Gy) and daily administration of gefitinib for two weeks, the administration of gefitinib was continued every other day in the outpatient clinic. During follow-up, CYFRA gradually increased to 3.8 ng/mL, but then decreased to the normal range. The tumor response rate of metastasized lymph nodes of bronchial bifurcation reached 36%, and it was confirmed to be a partial response. Without harmful phenomena except skin eruptions, her quality of life was good with a performance status (PS) 0 at 85 years 4 months of age, 9 years 2 months after the resection, with 2 years 5 months of gefitinib administration. It will be useful as a treatment option for octogenarians having postoperative recurrent lung cancers with every other day administration of gefitinib.