Letter to the Editor
Predicting lung nodules malignancy
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(A) CT reveals a crazy-paving appearance on the bilateral lungs. (B) Phospholipid-rich protein aggregates are clearly observed on the BALF smear through a direct smear for microscopic examination (1000×). (C) Wright–Giemsa staining reveals bluish-purple staining (1000×). (D) Periodic acid-Schiff-positive proteinaceous material is observed (1000×). (E) Oil red O staining reveals an orange aggregate (1000×).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Yan, Z. Wang, J. Zhao, J. Liu" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Yan" ] 1 => array:2 [ "nombre" => "Z." "apellidos" => "Wang" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Zhao" ] 3 => array:2 [ "nombre" => "J." 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Tinoco, G. Bermudo, V. Vicens-Zygmunt, P. Luburich, R. Llatjós, M. Molina-Molina" "autores" => array:6 [ 0 => array:2 [ "nombre" => "E.M." "apellidos" => "Tinoco" ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Bermudo" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Vicens-Zygmunt" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Luburich" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Llatjós" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Molina-Molina" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043722002616?idApp=UINPBA00004E" "url" => "/25310437/0000002900000004/v1_202307031326/S2531043722002616/v1_202307031326/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Predicting lung nodules malignancy" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "350" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "M. Guerra" "autores" => array:1 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Guerra" "email" => array:1 [ 0 => "migueldavidguerra@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Thoracic Surgery, Centro Hospitalar de Vila Nova de Gaia, Portugal" "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "Faculty of Medicine of Oporto, Portugal" "etiqueta" => "b" "identificador" => "aff0002" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0002" class="elsevierStylePara elsevierViewall">Jacob, et al.<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> in their original article “Predicting lung nodules malignancy” established a prediction model that can be used to assess the probability of malignancy in a Portuguese population, thereby providing help for the diagnosis of lung nodules. They also argue that their model can help decide the need for a lung biopsy and, thus reduce useless invasive techniques.<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a></p><p id="para0003" class="elsevierStylePara elsevierViewall">Every year, hundreds of thousands of patients are diagnosed with incidentally detected pulmonary nodules, and after lung cancer screening implementation, thousands more will be identified. However, the ideal approach for assessing pulmonary nodules is still vague, since most published guidelines<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> do not clearly state which strategy is accompanied by benefit outcomes, namely in surveillance, need for percutaneous/surgical biopsy or just clinical revaluation.</p><p id="para0004" class="elsevierStylePara elsevierViewall">With the emergence of new approaches such as uniportal and non-intubated video-assisted thoracic surgery (VATS) as well as exciting innovations in intra-operative imaging, VATS not only remains a reliable management option for patients with pulmonary nodules, but also an increasingly attractive one as side effects from anaesthesia and surgical access trauma are further minimized, and surgical accuracy improved.<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a></p><p id="para0005" class="elsevierStylePara elsevierViewall">Nowadays, awake non-intubated uniportal VATS wedge resection is one of the new frontiers in minimal invasive management of patients with solitary lung nodule and already a standard in the armamentarium of some Portuguese thoracic surgeons.<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> The emergence of image guided VATS, hybrid operating theatre and fluorescence thoracoscopy have all contributed to improved precision of VATS lung resection, and are becoming important adjuncts to lung sparing surgery when managing lung nodules diagnosis.</p><p id="para0006" class="elsevierStylePara elsevierViewall">Local anaesthesia awake procedures provide lower costs, shorter hospital stay, shorter anaesthesia and operation times compared to general anaesthesia patients. Other advantages include increased ventilation, fewer respiratory complications, shorter recovery time and it is not traumatic for the immune system which allows for faster recovery.<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a></p><p id="para0007" class="elsevierStylePara elsevierViewall">In conclusion, there is much debate on the best management of solitary pulmonary nodules. Even if they are mostly benign, they may represent an early-stage lung cancer. Minimally invasive surgical removal is probably the best approach to this insidious disease and should help keep VATS at the forefront of the diagnostic and therapeutic algorithm of lung nodules.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-11-12" "fechaAceptado" => "2022-11-21" "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting lung nodules malignancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Jacob" 1 => "J. Romano" 2 => "D. Araujo" 3 => "J.M. Pereira" 4 => "I. Ramos" 5 => "V. Hespanhol" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pulmoe.2020.06.011" "Revista" => array:6 [ "tituloSerie" => "Pulmonology" "fecha" => "2022" "volumen" => "28" "numero" => "6" "paginaInicial" => "454" "paginaFinal" => "460" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0002" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Mazzone P.J., Silvestri G.A., Souter L.H., Caverly T.J., Kanne J.P., Katki H.A., et al. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report Chest. 2021 Nov; 160(5): e427–e494. <a target="_blank" href="https://doi:10.1016/j.chest.2021.06.063">https://doi:10.1016/j.chest.2021.06.063</a>." ] ] ] 2 => array:3 [ "identificador" => "bib0003" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Uniportal video-thoracoscopic surgery: revolution or evolution" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Guerra" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Rev Port Cir Cardiotorac Vasc" "fecha" => "2015" "volumen" => "22" "numero" => "4" "paginaInicial" => "199" "paginaFinal" => "201" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28471135" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0004" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-intubated thoracoscopic lobectomies for lung cancer: an exploratory systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Prisciandaro" 1 => "L. Bertolaccini" 2 => "G. Sedda" 3 => "L. Spaggiari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/icvts/ivaa141" "Revista" => array:7 [ "tituloSerie" => "Interact Cardiovasc Thorac Surg" "fecha" => "2020" "volumen" => "31" "numero" => "4" "paginaInicial" => "499" "paginaFinal" => "506" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32918464" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/25310437/0000002900000004/v1_202307031326/S253104372200263X/v1_202307031326/en/main.assets" "Apartado" => array:4 [ "identificador" => "86736" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Correspondence" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25310437/0000002900000004/v1_202307031326/S253104372200263X/v1_202307031326/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S253104372200263X?idApp=UINPBA00004E" ]
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