J Thorac Dis. 2026 Feb 28;18(2):113. doi: 10.21037/jtd-2025-1393. Epub 2026 Feb 26.
ABSTRACT
BACKGROUND: Preoperative characterization of solitary pulmonary nodules is critical yet challenging, as distinguishing early-stage neoplasms from benign lesions is essential to prevent unwarranted anatomical resections. The study aimed to analyze the impact of preoperative positron emission tomography-computed tomography (PET-CT) on the incidence of video-assisted thoracoscopic surgery (VATS) lobectomy for unsuspected benign disease, in patients without preoperative diagnosis.
METHODS: The study included 864 patients, after VATS lobectomy, without the preoperative diagnosis, between January 1, 2014 and December 31, 2020, with 654 receiving preoperative PET-CT and 210 without it. The propensity score matching analysis was done, calculating the predicted probability using: age, sex, cardiovascular comorbidities, previous malignancy, chronic obstructive pulmonary disease (COPD), diabetes, and T category, obtaining equal groups of 210 patients with preoperative PET-CT (PET group) and without preoperative PET-CT (non-PET group). Univariate and multivariate analyses assessed the impact of the various factors on the incidence of benign postoperative diagnosis.
RESULTS: No significant difference was found in benign postoperative diagnosis between the PET and non-PET groups [n=6 (2.9%) vs. n=10 (4.8%), P=0.31; risk difference (RD): -0.019, 95% confidence interval (CI): -0.060 to 0.022] In the univariate analysis, younger age [60.75 vs. 65.5 years, P=0.02] and absence of COPD (4.6% vs. 0%, P=0.046), significantly influenced the risk of the postoperative unsuspected benign diagnosis. The younger age emerged as the sole significant risk factor for VATS lobectomy for benign lesions [P=0.042, odds ratio (OR) =1.062; 95% CI: 1.002-1.127].
CONCLUSIONS: The use of preoperative PET-CT did not decrease the risk of performing VATS lobectomy on unsuspected benign tumors. That risk should be considered when qualifying for VATS lobectomy, especially in younger patients.
PMID:41816418 | PMC:PMC12972788 | DOI:10.21037/jtd-2025-1393