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Analysis and CT Findings of Lung Nodules Proved by Surgical Pathology After CT-Guided Localization
摘要
PURPOSE. Preoperative computed tomography (CT)-guided pulmonary nodule localization facilitates resection of small or deep pulmonary nodules by video-assisted thoracoscopic surgery (VATS). The purpose of this study was to evaluate the safety and efficacy of preoperative CT-guided pulmonary nodule localization, and to correlate nodule characteristics on CT with surgical pathology. MATERIAL AND METHODS. We retrospectively reviewed 162 consecutive patients (83 males, mean age = 58.05 ± 11.75 years) with preoperative CT-guided localization using either hook wire (n = 104) or methylene blue (n = 62). Only CT images with less than 2.5 mm slice thickness were studied for better delineation of nodule characteristics. Pathological results and complications of intervention were also analyzed. Statistical significance was calculated with chi-square test and logistic regression. RESULTS. Preoperative CT-guided localization was performed on 162 patients with 166 pulmonary nodules (95 or 57.2% of nodules were malignant). The diameter of nodules ranged from 2 to 25 mm on CT images (mean = 8.36 ± 4.04 mm). Surgically proven malignancy or pre-cancerous lesions (adenocarcinoma in situ) were found in 15 (78.9%) of 19 ground-glass nodules (GGNs), 25 (78.1%) of 32 part-solid nodules, and 55 (47.8%) of 115 solid nodules. Nodule size ≥ 8.25 mm yielded a sensitivity of 61.1% and specificity of 81.7% for differentiating malignant from benign lesions. The average sizes of the malignant and benign nodules were 9.51 mm and 6.81 mm, respectively. Malignancies were more frequently observed in GGNs and part-solid nodules (p = 0.010). In the subsolid nodules of adenocarcinoma spectrum, a significant linear trend with invasive degree was found (homogeneous GGNs = 33%, heterogeneous GGNs = 76.9 % and part-solid nodules = 87.5%, p ＜ 0.050). All patients underwent successful operations on the same day. Fifty-eight patients (35.8%) had minimal to mild pneumothorax. Only 4 patients had significant pneumothorax that required chest tube decompression, and one patient had air-embolism resulting in altered level of consciousness that required endotracheal intubation. There was no mortality. All patients returned to the ward with stable vital signs. CONCLUSIONS. Preoperative CT-guided lung nodule localization is both safe and effective for small pulmonary nodule resection. From preoperative images, malignancies were associated with larger nodule size and part-solid or ground-glass density.