A Prospective Study to Determine the Incidence of Non-Imaged Malignant Pulmonary Nodules in Patients Who Undergo Metastasectomy by Thoracotomy With Lung Palpation
A Prospective Study to Determine the Incidence of Non-Imaged Malignant Pulmonary Nodules in Patients Who Undergo Metastasectomy by Thoracotomy With Lung Palpation
复制标题
DOI：
10.1016/j.athoracsur.2011.02.075
复制
发表时间：
2011-06-01
影响因子：
4.6
通讯作者：
Minnich, Douglas J.
中科院分区：
文献类型：
--
作者：
Cerfolio, Robert J.;Bryant, Ayesha S.;Minnich, Douglas J.
背景前瞻性评估双手肺触诊开胸行乳腺切除术患者中未成像恶性结节的发生率。这是一项前瞻性队列研究，研究对象为经开胸行开放性膀胱切除术的患者。所有患者均患有转移性肺部病变，均接受了64层螺旋计算机断层扫描（CT），使用5 mm准直切口进行静脉造影，大多数患者均接受了PET（正电子发射断层扫描）-CT。对术前未做影像学检查，但被触诊并切除的非可疑恶性肺结节进行记录。2006年1月至2010年3月，152例患者接受了由1名外科医生进行的保留肋骨、神经的开胸手术。51例（34%）患者有57个肺结节术前未成像，其中32个（56%）结节为恶性。30例患者有未成像的恶性结节，可触诊并切除。有15个恶性结节位于与成像结节不同的叶中。最常漏诊的3种恶性结节分别为结直肠癌、肾癌和肉瘤。通过开胸手术进行的转移瘤切除术，可提供双手触诊整个肺，在至少有1个成像转移性肺病灶的5例患者中，有1例发现同侧非成像恶性肺转移瘤。尽管术前进行了精细胸部CT造影扫描和18 F-氟脱氧葡萄糖-PET-CT扫描，但情况仍然如此。这些未成像的切除的恶性结节的临床意义尚不清楚，切除良性结节的额外发病率也不清楚。(Ann Thorac Surg 2011;91：1696-701）（C）2011年，胸外科医师协会
Background. To prospectively assess the incidence of non-imaged malignant nodules in patients who undergo thoracotomy for metastasectomy with bimanual lung palpation.Methods. This is a prospective cohort study of patients who underwent open metastasectomy by thoracotomy. All patients had metastatic lung lesions, underwent 64-slice helical computed tomographic (CT) scan with intravenous contrast using 5-mm collimated cuts, and most had integrated PET (positron emission tomography)-CT. Unsuspected malignant pulmonary nodules that were palpated and removed, and that were not imaged preoperatively, were recorded.Results. From January 2006 to March 2010, 152 patients underwent metastasectomy by rib-sparing, nerve-sparing thoracotomy by 1 surgeon. Fifty-one (34%) patients had 57 pulmonary nodules that were not imaged preoperatively and 32 of the 57 (56%) nodules were malignant. Thirty patients had non-imaged malignant nodules that were palpated and removed. There were 15 malignant nodules that were in different lobes than the imaged nodules. The 3 most commonly missed malignant nodules occurred in patients with colorectal cancer, renal cell, and sarcoma.Conclusions. Metastasectomy by thoracotomy, which affords bimanual palpation of the entire lung, discovers ipsilateral non-imaged malignant pulmonary metastases in 1 of 5 patients who had at least 1 imaged metastatic pulmonary lesion. This is true despite preoperative, fine cut chest CT scan with contrast, and integrated 18F-fluorodeoxyglucose-PET-CT scanning. The clinical significance of these non-imaged, resected malignant nodules is unknown, nor is the added morbidity of resecting benign nodules. (Ann Thorac Surg 2011;91:1696-701) (C) 2011 by The Society of Thoracic Surgeons