Computerized tomographic nodule heterogeneity: present and future impact on indications for sublobar resections.

Overview

With the advent of lung cancer screening, many nodules are being detected that are subsequently proven to be lung cancer. These nodules have different radiographic appearances and different biologic characteristics regarding their invasiveness and propensity for metastasis. These solid and part-solid nodules are now having surgeons reassess issues of lung sparing for early-stage lung cancer by not only considering smaller nodules as potentially appropriate for wedge resection or segmentectomies, but are also requiring surgeons to stratify these lesions by radiographic appearance. Data that argue for considering lesser resection of selected early-stage lung cancers, as well as the need for more prospectively accumulated facts that arise from trial designs like the original randomized Lung Cancer Study Group Trial, are discussed.