Oka Soichi, Shinohara Shuichi, Kuwata Taiji, Takenaka Masaru, Chikaishi Yasuhiro, Hirai Ayako, Ichiki Yoshinobu, Shimajiri Shohei, Aoki Takatoshi, Tanaka Fumihiro
Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
Department of Pathology and Cell Biology, University of Occupational and Environmental Health, Kitakyushu, Japan.
Ann Med Surg (Lond). 2017 Jun 20;20:13-18. doi: 10.1016/j.amsu.2017.06.025. eCollection 2017 Aug.
We actually investigated the surgical and pathological findings in cases which tumor invasion of the major thoracic vessels was suspected based on the preoperative Computed tomography (CT) findings.
We retrospectively reviewed our prospective database of all patients, who underwent lung resection for lung cancer from 2012 to 2014. 387 patients underwent lung cancer surgery. Among these patients, we analyzed 30 patients in whom pulmonary artery (PA) invasion was suspected and 11 patients in whom pulmonary vein (PV) or left atrium (LA) invasion was suspected based on the preoperative CT findings.
Among the 30 patients with suspected PA invasion, there were 9 patients in whom the tumor could be peeled off the PA in actual thoracotomy. Pathological invasion of the PA was observed in 6 of these patients. The positive predictive value of the preoperative CT findings was 20%. Among the 11 patients with suspected PV or LA invasion, there were 2 patients in whom the tumor could be peeled off the PV or LA in actual thoracotomy. Pathological tumor invasion of the PV or LA was observed in 4 of these patients. The positive predictive value of the preoperative CT findings was 36%.
The positive predictive value of the preoperative CT findings for tumor invasion of the thoracic vessels was low. Therefore, surgical opportunities that offer the chance of a cure shouldn't be missed in advanced lung cancer patients because the tumor is located near the major thoracic vessels on preoperative CT.
我们实际上调查了基于术前计算机断层扫描（CT）结果怀疑肿瘤侵犯胸段主要血管的病例的手术和病理结果。
我们回顾性分析了2012年至2014年所有因肺癌接受肺切除术患者的前瞻性数据库。387例患者接受了肺癌手术。在这些患者中，我们分析了30例根据术前CT结果怀疑肺动脉（PA）侵犯的患者和11例怀疑肺静脉（PV）或左心房（LA）侵犯的患者。
在30例怀疑PA侵犯的患者中，有9例在实际开胸手术中肿瘤可从PA上剥离。其中6例患者观察到PA的病理侵犯。术前CT结果的阳性预测值为20%。在11例怀疑PV或LA侵犯的患者中，有2例在实际开胸手术中肿瘤可从PV或LA上剥离。其中4例患者观察到PV或LA的病理肿瘤侵犯。术前CT结果的阳性预测值为36%。
术前CT结果对胸段血管肿瘤侵犯的阳性预测值较低。因此，对于晚期肺癌患者，不应因术前CT显示肿瘤位于胸段主要血管附近而错过提供治愈机会的手术时机。
