Lung-volume reduction surgery for severe pulmonary emphysema is an effective means of reducing dyspnea and improving pulmonary function. Preoperative evaluation of potential candidates may include computed tomography (CT), which may reveal unsuspected primary lung tumors. Rozenshtein and associates report their experience in patients with unsuspected lung cancer undergoing preoperative CT examination before lung-volume reduction surgery for severe emphysema.

A total of 148 patients with severe pulmonary emphysema who underwent lung-volume reduction surgery between September 1994 and March 1996 were included in the study. Preoperative chest CT revealed 18 pulmonary nodules suspicious of lung cancer in 17 (11 percent) of the 148 patients. At the time of lung reduction surgery, an attempt was made to excise all suspected lung cancers detected at CT. Sixteen of the tumors were resected.

Nine of the 16 resected nodules proved to be non-small cell carcinoma. The remaining seven nodules were benign. Histologic subtypes of the malignant nodules included adenocarcinoma and squamous cell carcinoma. Eight of the nine lung cancers were stage I. All of the carcinomas were peripheral, and their maximum diameters ranged from 1.0 to 3.8 cm (mean diameter: 2.1 cm). Only one patient with lung cancer had an accompanying aortopulmonary lymph node, measuring 1.5 cm on CT. Four patients underwent mediastinal lymph node biopsy, and no metastases were found.

The 5 percent frequency of stage I lung cancer in these patients with severe emphysema is higher than that reported in previous studies. The mean age (65 years) of the patients in the present study is comparable to that of patients in whom lung cancer is detected. The authors note that detection of lung cancer with CT in patients with severe emphysema in this study is about 10-fold higher than the detection rate of breast cancer on screening mammography.

The authors recommend preoperative CT examination in candidates for lung-volume reduction surgery. Increased use of this operation may lead to increased detection of early lung cancer in patients with severe emphysema.