The role of radiological and clinical findings in determining the decision of lobectomy in resectable lung lesions

OBJECTIVE: Lung cancer is the most common type of cancer in the world. It ranks first in cancer-related deaths in men and third in women after breast and colorectal cancer. Therefore, the diagnosis and treatment process of lung cancer patients should be managed well. The best curative treatment for lung cancer is anatomical surgical resection and systemic lymph node dissection. Therefore, accurate evaluation of the detected lung lesions is of great importance. Nowadays, the use of imaging modalities in the diagnosis of lung lesions has gradually increased and radiological findings provide an important resource for the treatment planning and management of patients. The aim of this study was to demonstrate the role of radiological and clinical findings in the decision of lobectomy in resectable lung lesions. MATERIALS AND METHODS: Our study was designed as retrospective and observational. The data of 135 patients who underwent lobectomy or wedge resection in the light of clinical and radiological data in the Department of Thoracic Surgery, Karadeniz Technical University Faculty of Medicine Farabi Hospital between January 2014 and April 2023 were analysed. Patients with undiagnosed lung lesions, who could not be diagnosed by transthoracic fine needle aspiration biopsy or endobronchial ultrasonography were included in the study. In this analysis, clinical variables were age, gender, smoking, extrapulmonary cancer history, family history of lung cancer, presence of chronic obstructive pulmonary disease / idiopathic pulmonary fibrosis; radiological variables were the size of the lesion, edge characteristics, internal structure of the lesion, relationship of the lesion with surrounding tissues and nuclear examination results. RESULTS: The study included 114 male and 21 female patients. The mean age of the patients was 60.8 ± 11.5 years. Malignant lesions were seen in 74 patients and benign lesions in 61 patients. The most common diagnosis in benign lesions was necrositant granulomatous inflammation, while the most common diagnosis in malignant lesions was adenocarcinoma. When the parameters used in the study were compared between benign and malignant lesions, age, location of the lesion, presence of pleural recession, moderate-high standardised maximum uptake (SUVmax) levels on positron emission tomography and computed tomography (PET-CT) were found to be associated with malignancy, whereas smoking, family history of cancer, presence of extrapulmonary cancer, spicular border feature of the lesion and attenuation characteristic were not found to be statistically significantly different between malignant and benign lesions. CONCLUSION: Accurate evaluation of lung lesions, identification of possible malignancy as soon as possible and application of correct treatment strategies are of great importance. In this thesis, the critical role of clinical and radiological data in the evaluation and treatment planning processes of undiagnosed pulmonary lesions was examined. The findings provide important information for the correct and effective management of pulmonary lesions. This emphasises the need for an individualised approach in the treatment planning of pulmonary lesions. Each patient is unique and treatment strategies should be customised based on clinical and radiological findings. In conclusion, clinical and radiological data should be evaluated together in the evaluation and treatment planning of pulmonary lesions. This is an important step in optimising treatment strategies for patients and may help to achieve the best treatment outcomes. Keywords: lung lesions, clinical findings, radiological findings, lobectomy