Workup
Laboratory Studies
- Perform a complete preoperative evaluation on all patients who undergo tissue sampling.
- The cell count helps to determine the general health status of the patient and also to diagnose complications such as pneumonia and anemia.
- Determine adequacy of the platelet function and perform coagulation studies before the patient undergoes any invasive procedures.
- Electrolytes and renal and liver function tests help to evaluate the presence of an abnormality that indicates the need for either intervention or further workup before performing an invasive procedure.
- Tuberculin skin test
- Sputum cytologic and microbiological studies
- A patient with a carcinoid tumor, with or without carcinoid syndrome, may exhibit a high level of serotonin and 5-hydroxyindoleacetic acid (5-HIAA).
- Arterial blood gas and pulmonary function tests (PFTs) are indicated in patients presenting with shortness of breath and are indicated before invasive procedures or thoracotomy. The presence of hypoxia and hypercarbia generally suggests poor tolerability for resective surgery. PFTs are useful tests when determining patients' suitability for lung resection. Patients must have satisfactory parameters as measured by forced expiratory volume in one second (FEV1) and diffusion capacity of lung for carbon monoxide (DLCO).
- Recently, bronchoscopic resection offers an alternative to surgical resection of benign endobronchial tumors. At 1 and 10 years, respectively, 100% and 94% of completely resected carcinoids were free of disease.2
Imaging Studies
- Chest radiograph (posteroanterior [PA] and lateral views) is required. Review all previous chest radiographs when available. Reviewing helps to determine the onset and doubling time. Chest radiograph provides information about size, morphology, the presence of calcifications, and spicula. Benign lesions tend to have calcium deposited in central, peripheral, concentric, "popcorn," or homogeneous patterns, whereas eccentric patterns of calcifications are more characteristic of malignancies. These characteristics help when determining if the tumor is benign or malignant, although not with certainty. If a lesion has not changed over 2 years on radiographic evaluation, that lesion can generally be safely considered benign.
- Perform a chest computed tomography (CT) scan with and without contrast. Using both contrast and noncontrast examinations can help delineate calcification, can better confirm hamartomas and arteriovenous malformations, and can enhance the appearance of malignant tumors. Using iodinated contrast also provides more details about size, the presence of satellite lesions, the status of perihilar and mediastinal lymph nodes, and, when used in conjunction with noncontrast studies, it provides a more detailed definition of calcification.
- Use of MRI is limited; however, it is useful in defining tumor invasion of the great vessels.
- Positron emission tomography (PET) has been advanced as a method to distinguish benign lung tumors from malignant lung tumors. Unfortunately, some overlap exists with PET scanning, some lesions remain indeterminate even after PET scanning, and some lung cancers (bronchoalveolar) are not metabolically active on PET imaging.
Other Tests
- ECG is required before surgery as part of the preoperative cardiac risk factor assessment. Address the presence of major arrhythmia and ischemia before performing the planned procedure.
Diagnostic Procedures
- Fiberoptic bronchoscopy: Both rigid and fiberoptic bronchoscopy are useful for diagnosing endobronchial benign lung tumors. Biopsy or bronchial brushing can be performed with this procedure, as well as excision of pedunculated endobronchial lesion. Sensitivity for detection of malignancy is 10-30% when nodules are peripheral and small (<2 cm). However; recent advances in bronchoscopy, such as electromagnetic navigation and endobronchial ultrasound-guided transbronchial needle biopsy, may offer improved results in the evaluation of pulmonary nodules and mediastinal adenopathy.3 Bronchoscopic resection also offers an alternative to surgical resection for benign endobronchial tumors. At 1 and 10 years, respectively, 100% and 94% of completely resected carcinoids were free of disease.2
- Percutaneous biopsy/guided transthoracic needle aspiration biopsy: The tumor must be easily accessible. Percutaneous biopsy/guided transthoracic needle aspiration biopsy is performed under CT scan or fluoroscopy guidance and has a yield as high as 85% for diagnosis. A major complication is pneumothorax, with an incidence that may be as high as 20-25%.
- Video-assisted thoracoscopy:4,5,6 A biopsy can be obtained from a superficial pleural-based lesion, or the lesion can be resected using this approach.
- Open biopsy: This procedure may occasionally be required when the etiology of a pulmonary nodule is questioned after thorough workup. Thoracotomy is planned after the appropriate workup and plan of management is decided. The extent of resection is decided intraoperatively.
Histologic Findings
See Pathophysiology.
More on Benign Lung Tumors |
| Overview: Benign Lung Tumors |
 Workup: Benign Lung Tumors |
| Treatment: Benign Lung Tumors |
| Follow-up: Benign Lung Tumors |
| References |
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References
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Further Reading
Keywords
lung tumor, lung tumors, benign lung tumor, benign lung neoplasms, lung cancer, lung lesion, pulmonary nodules, primary lung tumors, neoplastic lesions, pneumonia, atelectasis, hemoptysis, hamartomas, bronchial adenomas, chondroadenomas, bronchial cystadenomas, mucous gland adenomas, tracheobronchial tumors, parenchymal tumors, sclerosing hemangioma, lung treatment
