Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
Ann Thorac Surg. 2010 Jan;89(1):212-8. doi: 10.1016/j.athoracsur.2009.09.075.
Preoperative localization of pulmonary nodules is sometimes necessary when they are too small or distant from the surface of the visceral pleura to be detected during video-assisted thoracoscopic surgery. This study aims to present the criteria for localization and to evaluate the accuracy of the criteria.
From April 2001 to March 2008, 178 patients with 224 nodules who underwent wedge resection of pulmonary metastatic nodules by video-assisted thoracoscopic surgery were reviewed retrospectively. Thirty-one patients (17.4%) including 35 nodules underwent thoracoscopic resection immediately after computed tomography-guided localization using hook wires. Criteria for preoperative localization were (1) maximum diameter of the nodule of 5 mm or less, (2) maximum diameter to minimum distance between the visceral pleura and inferior border of nodule of 0.5 or less, and (3) nodule with low-density image by computed tomography after chemotherapy. The accuracy of these inclusion criteria was statistically evaluated.
All 224 nodules were removed by wedge resection or additional segmentectomy. Nineteen nodules (54.3%) were detected in the thoracic cavity with preoperative localization. Sensitivity, specificity, positive predictive value, and negative predictive value were 11.1%, 99.5%, 66.7%, and 92.8%; 88.9%, 93.2%, 53.3%, and 99.0%; and 88.9%, 90.8%, 45.7%, and 98.9% in each preoperative finding of which a nodule met all (3 nodules), two or more (30 nodules), and one or more (35 nodules) of the three criteria, respectively.
This study suggests that preoperative localization should be considered before video-assisted thoracoscopic surgery operation if the pulmonary nodule meets two or more of our criteria.
当肺结节太小或距离内脏胸膜较远，无法在电视辅助胸腔镜手术中检测到时，有时需要进行术前定位。本研究旨在提出定位标准并评估其准确性。
回顾性分析 2001 年 4 月至 2008 年 3 月期间，178 例 224 个肺转移结节患者行电视辅助胸腔镜楔形切除术的资料。31 例（17.4%）患者包括 35 个结节在 CT 引导下钩线定位后立即行胸腔镜切除术。术前定位标准为：（1）结节最大直径 5mm 或以下；（2）结节最大直径与脏层胸膜下界之间的最短距离为 0.5cm 或以下；（3）化疗后 CT 显示为低密度影。统计评估这些纳入标准的准确性。
224 个结节均行楔形切除或附加节段切除术切除。19 个结节（54.3%）在术前定位时被胸腔内发现。敏感性、特异性、阳性预测值和阴性预测值分别为 11.1%、99.5%、66.7%和 92.8%；88.9%、93.2%、53.3%和 99.0%；以及 88.9%、90.8%、45.7%和 98.9%，分别在结节满足所有（3 个结节）、2 个或以上（30 个结节）和 1 个或以上（35 个结节）的 3 个标准中的术前发现。
如果肺结节符合我们的 2 个或更多标准，建议在电视辅助胸腔镜手术前考虑术前定位。
