From the Divisions of Cardiothoracic Imaging (J.C.L.R., K.H., J.K., T.B.C., M.P., E.T.N.), Thoracic Surgery (A.F.P., T.K.W., S.K., M.C., K.Y.), and Thoracic Pathology (M.C.), Toronto General Hospital, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2; Postgraduate Medical Education, Department of Medical Imaging, University of Toronto, Toronto, Canada (J.C.L.R.); and Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, England, United Kingdom, BA1 3NG (J.C.L.R.).
Radiology. 2019 Apr;291(1):214-222. doi: 10.1148/radiol.2019181674. Epub 2019 Feb 5.
Background CT-guided microcoil localization has been shown to reduce the need for thoracotomy or video-assisted thoracoscopic surgery (VATS) anatomic resection. However, only short-term follow-up after CT-guided microcoil localization and lung resection has been previously reported. Purpose To assess the diagnostic utility and recurrence-free survival over a minimum of 2 years following CT-guided microcoil localization and VATS. Materials and Methods Among 1950 VATS procedures performed in a single tertiary institution from October 2008 through April 2016, 124 consecutive patients with CT-guided microcoil localization were retrospectively evaluated. Patient demographics, nodule characteristics, and histopathologic findings were recorded. The primary end point was recurrence-free survival after 2 or more years of CT surveillance. Statistical analysis included Kaplan-Meier survival curves and Cox regression. Results In 124 patients (men, 35%; mean age, 65 years ± 12) with a nodule found at CT, microcoil localization and VATS resection were performed for a total of 126 nodules (mean size, 13 mm ± 6; mean distance to pleura, 20 mm ± 9). On presurgical CT evaluation, 42% (53 of 126) of nodules were solid, 33% (41 of 126) were ground glass, and 24% (30 of 126) were subsolid. VATS excisional biopsy altered cytopathologic diagnosis in 21% (five of 24) of patients with prior diagnostic premicrocoil CT-guided biopsy. At histopathologic examination, 17% (21 of 126) of the nodules were adenocarcinoma in situ, 17% (22 of 126) were minimally invasive adenocarcinoma, 30% (38 of 126) were invasive lung primary tumors, and 22% (28 of 126) were metastases. Among the 72 patients with malignancy at histopathologic examination and at least 2 years of CT surveillance, local recurrence occurred in 7% (five of 72), intrathoracic recurrence in 22% (16 of 72), and extrathoracic recurrence in 18% (13 of 72) after 2 or more years of CT surveillance. There was no recurrence for adenocarcinoma in situ, minimally invasive adenocarcinoma, or invasive lung tumors measuring less than 1 cm. After multivariable adjustment, nodule location at a distance greater than 10 mm from the pleura was an independent predictor of time to recurrence (hazard ratio, 2.9 [95% confidence interval: 1.1, 7.4]; P = .03). Conclusion CT-guided microcoil localization and video-assisted thoracoscopic surgical resection alter clinical management and were associated with excellent recurrence-free survival for superficial premalignant, minimally invasive, and small invasive lung tumors. © RSNA, 2019 Online supplemental material is available for this article.
背景 CT 引导下微线圈定位已被证明可减少开胸手术或电视辅助胸腔镜手术（VATS）解剖性切除的需要。然而，之前仅报道了 CT 引导下微线圈定位和肺切除术后的短期随访。目的 评估 CT 引导下微线圈定位和 VATS 后至少 2 年的诊断效用和无复发生存率。材料与方法 在 2008 年 10 月至 2016 年 4 月期间，在一家三级医疗机构进行的 1950 例 VATS 手术中，回顾性评估了 124 例连续接受 CT 引导下微线圈定位的患者。记录患者的人口统计学、结节特征和组织病理学发现。主要终点是 CT 监测 2 年以上后的无复发生存率。统计分析包括 Kaplan-Meier 生存曲线和 Cox 回归。结果 在 124 例（男性 35%；平均年龄 65 岁±12 岁）因 CT 发现结节而接受微线圈定位和 VATS 切除的患者中，总共切除了 126 个结节（平均大小 13 mm±6；平均距胸膜 20 mm±9）。术前 CT 评估显示，42%（53/126）的结节为实性，33%（41/126）为磨玻璃密度，24%（30/126）为部分实性。VATS 切除活检改变了 21%（5/24）先前接受微线圈 CT 引导活检的患者的细胞学诊断。组织病理学检查发现，17%（21/126）的结节为原位腺癌，17%（22/126）为微浸润性腺癌，30%（38/126）为浸润性肺原发性肿瘤，22%（28/126）为转移瘤。在 72 例组织病理学检查为恶性且至少接受 2 年 CT 监测的患者中，局部复发率为 7%（5/72），胸内复发率为 22%（16/72），胸外复发率为 18%（13/72）。2 年以上 CT 监测后，原位腺癌、微浸润性腺癌或小于 1 cm 的浸润性肺肿瘤无复发。多变量调整后，距离胸膜大于 10 mm 的结节位置是复发时间的独立预测因素（危险比，2.9[95%置信区间：1.1，7.4]；P=.03）。结论 CT 引导下微线圈定位和 VATS 切除改变了临床管理，并为浅表性癌前、微浸润性和小浸润性肺肿瘤提供了极好的无复发生存率。
