| Accuracy of helical CT in the detection of pulmonary metastases: is intraoperative palpation still necessary? | |
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MedLine Citation:
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PMID: 15561000 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Pulmonary metastasectomy is well accepted in patients with isolated metastases from an extrathoracic malignancy. The standard approach involves careful intraoperative palpation of the lungs because more metastases are frequently found than were seen by preoperative conventional computed tomography (CT). Helical CT detects more nodules than conventional CT, raising the question of whether palpation of the lungs is still necessary if helical CT is used. METHODS: Retrospective review was done of medical records of patients undergoing metastasectomy with curative intent at the University of North Carolina (UNC) from 1999 to 2003. During this time at UNC, helical CT was routinely performed using a standardized technique, and all metastasectomy patients underwent manual lung palpation. The primary outcome measure of this study was whether malignant nodules (palpated, resected, and proven histologically) were reliably detected preoperatively by helical CT. RESULTS: Thirty-four patients were identified who underwent 41 cases of pulmonary metastasectomy with lung palpation. Our analysis revealed that in 22% (9/41), more malignant nodules were found intraoperatively than were detected by helical CT. Of 88 malignant intraparenchymal nodules, 69 were detected by helical CT (sensitivity 78%). Subset analyses of tumor histology, disease-free interval, the presence of a single lesion versus multiple lesions, the interval between the CT and metastasectomy, and the size of the largest lesion were unable to identify a cohort in which lung palpation was no longer needed after preoperative helical CT. CONCLUSIONS: Despite the advent of helical CT, palpation of the lung is necessary if the goal is to resect all detectable disease. |
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Authors:
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Alden M Parsons; Frank C Detterbeck; Leonard A Parker |
Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 78 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2004 Dec |
Date Detail:
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Created Date: 2004-11-24 Completed Date: 2005-07-05 Revised Date: 2005-11-16 |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 1910-6; discussion 1916-8 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7065, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Diagnostic Errors* Female Humans Intraoperative Period Lung Neoplasms / diagnosis, radiography*, secondary*, surgery Male Middle Aged Palpation* Preoperative Care Pulmonary Surgical Procedures Retrospective Studies Sarcoma / diagnosis, radiography, secondary, surgery Sensitivity and Specificity Tomography, Spiral Computed* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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