Heaton Todd E, Hammond William J, Farber Benjamin A, Pallos Valerie, Meyers Paul A, Chou Alexander J, Price Anita P, LaQuaglia Michael P
Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
J Pediatr Surg. 2017 Jan;52(1):115-119. doi: 10.1016/j.jpedsurg.2016.10.034. Epub 2016 Oct 27.
Cooperative studies support complete metastasectomy in osteosarcoma (OS). Pre-operative CT is used to identify and quantify metastases and can facilitate minimally invasive techniques. Here we assess the accuracy of pre-operative CT compared to findings at thoracotomy and its change over time.
We reviewed OS thoracotomies performed at our institution from 1996 to 2015. The number of metastases identified on pre-operative chest CT was compared to the number of metastases seen on pathology (both metastases with viable cells and non-viable, osteoid-only metastases).
Eighty-eight patients underwent 161 thoracotomies with a median of 14days (range, 1-85) between CT and surgery, a median of 2 CT-identified lesions (range, 0-15), and a median of 4 resected lesions (range, 1-25). In 56 (34.8%) cases, more metastases were found surgically than were seen on CT, and among these, 34 (21.1%) had a greater number of viable metastases. There was poor overall correlation between CT and pathology findings (Kendall Tau-b=0.506), regardless of CT slice thickness, decade of thoracotomy, or total number of CT-identified lesions.
CT accuracy in pre-operatively quantifying OS pulmonary metastases has not improved in recent decades. Consequently, we recommend an open technique with direct lung palpation for complete identification and resection of OS pulmonary metastases.
Level IV, retrospective study with no comparison group.
合作研究支持骨肉瘤（OS）的完整转移灶切除术。术前CT用于识别和量化转移灶，并有助于采用微创技术。在此，我们评估术前CT与开胸手术结果相比的准确性及其随时间的变化。
我们回顾了1996年至2015年在本机构进行的OS开胸手术。将术前胸部CT上识别出的转移灶数量与病理检查中发现的转移灶数量进行比较（包括有活细胞的转移灶和无活性的仅骨样转移灶）。
88例患者接受了161次开胸手术，CT检查与手术之间的中位间隔时间为14天（范围1-85天），CT识别出的病变中位数量为2个（范围0-15个），切除的病变中位数量为4个（范围1-25个）。在56例（34.8%）病例中，手术中发现的转移灶比CT上看到的更多，其中34例（21.1%）有更多的有活性转移灶。CT与病理结果之间的总体相关性较差（肯德尔Tau-b=0.506），无论CT切片厚度、开胸手术的年代或CT识别出的病变总数如何。
近几十年来，CT术前定量骨肉瘤肺转移灶的准确性并未提高。因此，我们建议采用直接触诊肺的开放技术，以完整识别和切除骨肉瘤肺转移灶。
IV级，无比较组的回顾性研究。
