Faculty of Medicine, Department of Surgery II, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
Faculty of Medicine, Department of Radiology, Division of Diagnostic Radiology, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
Gen Thorac Cardiovasc Surg. 2023 Aug;71(8):464-471. doi: 10.1007/s11748-023-01912-z. Epub 2023 Feb 5.
Pleural adhesions are challenging during lung cancer surgery and may be associated with a long surgery time and excessive blood loss due to pleural adhesiolysis. We used preoperative four-dimensional computed tomography to quantitatively assess parietal pleural adhesions and determine its diagnostic accuracy.
A total of 216 patients with lung cancer underwent four-dimensional computed tomography during the study period. Pleural adhesions were subsequently confirmed by surgery in 85 of these patients, whereas 126 patients had no adhesions. The movements of the tumor or target vessels (α) was tracked. Receiver-operating characteristic curve analysis was used to identify the relationship between adhesions and (α).
The movement of (α) was smaller in patients with adhesions than in those without adhesions. The greater the adhesion, the shorter the movement distance (p < 0.001). Receiver-operating characteristic curve analysis demonstrated an area under the curve for the moving (α) point at 0.71 (95% confidence interval: 0.62-0.80) in the upper lung field and at 0.75 (95% confidence interval: 0.64-0.85) in the lower field. To identify adhesions, a cut off of 11.3 mm (sensitivity = 43.6%, specificity = 93.2%) in the upper lung field and a cut off of 41.2 mm (sensitivity = 71.4%, specificity = 66.0%) in the lower lung field were established.
Four-dimensional computed tomography is a novel and helpful modality for predicting the presence of parietal pleural adhesions. To obtain robust evidence, further accumulation of cases and re-examination of the analysis methods are needed.
肺癌手术中胸膜粘连是一个挑战，可能会由于胸膜松解而导致手术时间延长和失血过多。我们使用术前四维 CT 定量评估壁层胸膜粘连，并确定其诊断准确性。
本研究共纳入 216 例肺癌患者，其中 85 例患者术中证实存在胸膜粘连，126 例患者无粘连。跟踪肿瘤或靶血管（α）的运动。使用受试者工作特征曲线分析确定粘连与（α）之间的关系。
粘连患者的（α）运动幅度小于无粘连患者。粘连越严重，运动距离越短（p<0.001）。受试者工作特征曲线分析显示，上肺野（α）移动点的曲线下面积为 0.71（95%置信区间：0.62-0.80），下肺野为 0.75（95%置信区间：0.64-0.85）。为了识别粘连，在上肺野，截断值为 11.3mm（敏感性=43.6%，特异性=93.2%），在下肺野，截断值为 41.2mm（敏感性=71.4%，特异性=66.0%）。
四维 CT 是一种预测壁层胸膜粘连的新方法。为了获得更可靠的证据，需要进一步积累病例并重新检查分析方法。
