Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, CHUM Endoscopic Tracheobronchial and Oesophageal Center, University of Montréal, Montréal, Québec, Canada.
J Thorac Cardiovasc Surg. 2012 Nov;144(5):1160-5. doi: 10.1016/j.jtcvs.2012.08.034. Epub 2012 Sep 12.
To investigate the feasibility, accuracy, and effect on conversion rates of intracavitary video-assisted thoracoscopic surgery ultrasonography (VATS-US) for localization of difficult to visualize pulmonary nodules.
The study consisted of a prospective cohort of VATS-US for localization of intraparenchymal peripheral pulmonary nodules. Patients with pulmonary nodules not touching the visceral pleura on the computed tomography scan, who were scheduled for VATS wedge resection, were prospectively enrolled. The lobe of interest was examined: visually, using finger palpation when possible, and using the instrument sliding method. The nodule was then sought using a sterile ultrasound transducer. The primary outcome measure was the prevention of conversion to thoracotomy or lobectomy secondary to positive VATS-US findings in patients with nodules that were not identifiable using standard VATS techniques.
Four different surgeons performed 45 individual VATS-US procedures during a 13-month period. Intracavitary VATS-US was able to detect 43 of 46 nodules. The sensitivity of VATS-US was 93%, and the positive predictive value was 100%. The lung nodules were visualized by thoracoscopic lung examination in 12 cases (27%), palpable by finger in 18 cases (40%), and palpable using the instrument sliding technique in 17 cases (38%). In 20 cases, lung nodules were not identifiable using any of the traditional techniques and were identified only with VATS-US. VATS-US, therefore, prevented conversion to thoracotomy or lobectomy without tissue diagnosis in 43% (20/46) of cases.
Intracavitary VATS-US is a real-time, feasible, reliable, and effective method of localization of intraparenchymal pulmonary nodules during selected VATS wedge resection procedures and can decrease the conversion rates to thoracotomy or lobectomy.
研究腔内视频辅助胸腔镜超声（VATS-US）定位难以可视化肺结节的可行性、准确性和对转化率的影响。
本研究包括一项 VATS-US 定位肺实质周围肺结节的前瞻性队列研究。对计算机断层扫描扫描未触及内脏胸膜的肺结节患者，计划行 VATS 楔形切除术的患者，前瞻性入组。检查感兴趣的叶：尽可能使用手指触诊，或使用仪器滑动法进行视诊。然后使用无菌超声探头寻找结节。主要观察指标是在使用标准 VATS 技术无法识别结节的患者中，因 VATS-US 发现阳性而避免转为开胸手术或肺叶切除术的情况。
在 13 个月的时间里，4 位不同的外科医生共进行了 45 次单独的 VATS-US 操作。腔内 VATS-US 能够检测到 46 个结节中的 43 个。VATS-US 的灵敏度为 93%，阳性预测值为 100%。12 例（27%）通过胸腔镜肺检查可见肺结节，18 例（40%）手指可触及，17 例（38%）使用仪器滑动技术可触及。在 20 例中，传统技术无法识别肺结节，仅通过 VATS-US 识别。因此，VATS-US 可在 43%（20/46）的病例中防止无需组织诊断而转为开胸手术或肺叶切除术。
腔内 VATS-US 是一种实时、可行、可靠且有效的方法，可用于在选定的 VATS 楔形切除术中定位肺实质内的肺结节，并可降低转为开胸手术或肺叶切除术的转化率。
