Operative ultrasonography for lung cancer surgery.

During 60 operations for lung cancer, high-resolution (7.5 MHz) operative ultrasonography was performed to evaluate direct cardiovascular invasion of tumor (24 operations), lymph node metastasis (30 operations), liver metastasis (13 operations). Immediately after thoracotomy or sternotomy but before tissue dissection, operative scanning enabled delineation and evaluation of the evaluation of the vessels and heart (atrium) behind or within the tumor and detection of regional lymph nodes. The accuracy of operative ultrasound in diagnosing the presence or the extent of cardiovascular invasion was 91.7% (22 of 24 operations), which was significantly (p less than 0.02) higher than preoperative studies (62.5%), including computed tomography and angiography. Of the 24 surgical procedures, 23 were consistent with operations proposed on the basis of operative ultrasound findings, whereas only 16 were consistent with preoperatively proposed (p less than 0.01). Operative ultrasound provided the capability of depicting lymph nodes as small as 3 mm. More lymph nodes (8.0 +/- 1.84 nodes per cancer) were detected with operative ultrasound than with computed tomography (4.8 +/- 1.56 nodes) (p less than 0.001); however, the sensitivity and specificity of operative ultrasound in determining lymph node metastasis were 82.4% and 67.3%, respectively. No liver metastasis was identified. The information provided by operative ultrasound regarding cardiovascular invasion and lymph node and liver metastasis was considered helpful in selecting the type of surgical procedure an in avoiding unnecessary tissue dissection.