The discovery of a solitary pulmonary nodule has long presented physician and patient with a difficult decision. The article by Nathan in this issue of The Journal makes it appear as if the decision were an easy one. This conversion from complexity to simplicity is, unfortunately, more illusion than reality. It is accomplished not with mirrors but with statistics plus one major omission: the contribution of the individual patient to the decision-making matrix. Alas, in the real world, there are only patients, not statistics, or, put another way, one must stop at the bedside on the path between the library and the ultimate decision.
There are three basic facts about the patient with a solitary pulmonary nodule, on which everyone can agree: (1) a substantial percentage of these patients have benign nodules, (2) five-year survival rates among patients with resection of malignant nodules are substantially higher than in other bronchogenic
Moser KM. Solitary Pulmonary Nodules. JAMA. 1974;227(10):1167–1168. doi:10.1001/jama.1974.03230230043024
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