Kitazawa Shinsuke, Bernards Nicholas, Gregor Alexander, Sata Yuki, Hiraishi Yoshihisa, Ogawa Hiroyuki, Koga Takamasa, Ishiwata Tsukasa, Aragaki Masato, Yokote Fumi, Effat Andrew, Kazlovich Kate, Weersink Robert, Cabanero Michael, Sato Yukio, Yasufuku Kazuhiro
Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Interdiscip Cardiovasc Thorac Surg. 2024 Dec 25;40(1). doi: 10.1093/icvts/ivae211.
Computed tomography (CT) imaging of a sublobar resection specimen may inform intraoperative surgical margin assessment. However, consistency with final pathological margins has not been previously evaluated. In this study, we investigated the concordance between surgical margin measurements by CT versus pathology measurements using an ex vivo sublobar lung resection model.
Pig lung wedge samples containing agarose pseudotumours were harvested. CT images were acquired following specimen inflation. The specimen was bisected along the same plane observed by CT for accurate comparison with pathological surgical margin measurement. The bisected samples were then fixed in formalin before preparing haematoxylin & eosin slides. Surgical margin length at four distinct stages (CT, gross pre-formalin fixation, gross post-formalin fixation and pathology) were measured and compared.
A total of 50 lung specimens were analysed. After specimen processing, Surgical margin length decreased in 94% (47/50) and increased in 6% (3/50) of samples. Mean surgical margin lengths were as follows: CT 14.0 mm (range: 4.5-28.3 mm), gross pre-formalin fixation 13.0 mm (range: 4.0-25.0 mm), gross post-formalin fixation 12.1 mm (range: 2.5-26.0 mm) and pathology 10.9 mm (range: 1.0-23.4 mm). There was an average -23.8% (range: +11 to -82%) change in surgical margin length from CT to final pathology (P < 0.001).
While CT-based surgical margin measurement is feasible, we observed an average 23.8% discordance when compared to final pathology measurement. Surgeons must be aware that the CT-derived surgical margin generally overestimates the pathology-derived surgical margin.
亚肺叶切除标本的计算机断层扫描（CT）成像可为术中手术切缘评估提供信息。然而，此前尚未评估其与最终病理切缘的一致性。在本研究中，我们使用离体亚肺叶肺切除模型，研究了CT测量的手术切缘与病理测量结果之间的一致性。
采集含有琼脂糖假瘤的猪肺楔形样本。标本充气后进行CT图像采集。沿CT观察的同一平面将标本一分为二，以便与手术病理切缘测量结果进行准确比较。然后将切开的样本固定在福尔马林中，再制备苏木精和伊红切片。测量并比较四个不同阶段（CT、福尔马林固定前大体标本、福尔马林固定后大体标本和病理）的手术切缘长度。
共分析了50个肺标本。标本处理后，94%（47/50）的样本手术切缘长度缩短，6%（3/50）的样本手术切缘长度增加。平均手术切缘长度如下：CT为14.0毫米（范围：4.5 - 28.3毫米），福尔马林固定前大体标本为13.0毫米（范围：4.0 - 25.0毫米），福尔马林固定后大体标本为12.1毫米（范围：2.5 - 26.0毫米），病理为10.9毫米（范围：1.0 - 23.4毫米）。从CT到最终病理，手术切缘长度平均变化-23.8%（范围：+11%至-82%）（P < 0.001）。
虽然基于CT的手术切缘测量是可行的，但与最终病理测量相比，我们观察到平均有23.8%的不一致性。外科医生必须意识到，CT得出的手术切缘通常会高估病理得出的手术切缘。
