Missed pulmonary metastasis

Althagafi, Khalid Turki; Alashgar, Omniyah; Almaghrabi, Huda Saddig; Nasralla, Awrad; Ahmed, Mohamed; Alshehri, Ameen; Saleh, Waleed; Alkattan, Khaled

doi:10.1177/0218492313487081

Cited by 19 publications

(8 citation statements)

References 10 publications

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“…This is supported by other reports, showing that even in 26% to 36% of the cases, the number of preoperative identified PM on conventional or high-resolution chest CT scan was lower than the number of PM found during the operation and found on pathological investigation. 47,48 These data, together with our results, suggests the need of manual palpation of the lung during lung metastasectomy to identify all PM.…”

Section: Discussionsupporting

confidence: 70%

Phase II Multicenter Clinical Trial of Pulmonary Metastasectomy and Isolated Lung Perfusion with Melphalan in Patients with Resectable Lung Metastases

Hengst

Hendriks

Balduyck

et al. 2014

Journal of Thoracic Oncology

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Section: Discussionsupporting

confidence: 70%

Phase II Multicenter Clinical Trial of Pulmonary Metastasectomy and Isolated Lung Perfusion with Melphalan in Patients with Resectable Lung Metastases

Hengst

Hendriks

Balduyck

et al. 2014

Journal of Thoracic Oncology

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“…However, it proved to be useful since it significantly added sensitivity to the performance of the radiologist alone. Not surprisingly, manual palpation was found to be the most sensitive method in our study which is consistent with other studies [18][19][20][21]. However, a higher proportion of non-palpable lesions was metastatic in our study, thus emphasizing the potential benefit of CT with CAD as guidance for the surgeon.…”

Section: Discussionsupporting

confidence: 92%

“…However, the absolute number of these lesions in which sufficient follow-up information was available was small. In surgical studies not using CAD, CT performance was markedly inferior compared to our data, with lung metastases missed on CT in up to 36 % of cases [5,[18][19][20][21]. This is an indirect argument for the use of CAD in addition to the review of the CT scan by the radiologist.…”

Section: Discussioncontrasting

confidence: 86%

Contribution of CAD to the Sensitivity for Detecting Lung Metastases on Thin-Section CT – A Prospective Study with Surgical and Histopathological Correlation

Meybaum¹,

Graff²,

Fallenberg

et al. 2019

Fortschr Röntgenstr

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Purpose To assess the sensitivity of radiologists and a CAD system for the detection of lung metastases on thin-section computed tomographic (CT) scans prior to pulmonary metastasectomy. Materials and Methods All patients scheduled for resection of lung metastases were eligible for this prospective single-center trial. 95 patients with 115 surgical procedures (pulmonary metastasectomy using thoracotomy) were included. An experienced radiologist examined the CT scans for pulmonary metastases and documented his findings. A commercial CAD system was used as a second reader; additional CAD findings were recorded. A comparison of the sensitivity of the radiologist alone and with CAD was performed. Intraoperatively surgeons tried to identify the documented lesions and resected them as well as additionally palpable lesions. The standard of reference consisted of surgery and histopathology. Follow-up information for radiologically detected lesions missed during surgery was sought. Results 693 lesions (262 metastases) were detected radiologically or surgically, 646 of them were resected. The sensitivity of radiologists without CAD was 67.5 % for all lesions (87.4 % for metastases). CAD highly significantly (p < 0.001) increased the sensitivity to 77.9 % (92.7 %). During surgery, 143 additional lesions (19 metastases) were detected. 49 radiologically detected lesions were not palpable during surgery: 4 metastases, 5 benign lesions, and 40 lesions of an unknown nature. Conclusion CAD provides significant additional sensitivity for detecting lung metastases using MDCT compared to the performance of a radiologist alone. CT reveals a relevant number of non-palpable pulmonary lesions. Key Points: Citation Format

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“…Patients with a median number of 2 imaged pulmonary nodules were more likely to have occult metastases than those with 1.2 imaged pulmonary nodules (P = 0.001) [16]. Patients with primary mesenchymal tumours were more likely to have occult metastases than those with epithelial tumours (41 vs 29%) [17]. In a case series with osteosarcoma patients, helical CT imaged only 183 nodules, whereas manual palpation found additional 146 nodules [7].…”

Section: Resultsmentioning

confidence: 95%

“…The 18 studies included report on 1472 patients with lung metastases from different primary cancers [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The patients underwent more than 1630 pulmonary metastasectomies between 1990 and 2014.…”

Section: Resultsmentioning

confidence: 99%

Is manual palpation of the lung necessary in patients undergoing pulmonary metastasectomy?: Table 1:

Macherey

Doerr

Heldwein

et al. 2015

Interact CardioVasc Thorac Surg

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A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether manual palpation of the lung is necessary in patients undergoing pulmonary metastasectomy. In total, 56 articles were found using the described search strategy. After screening these articles and their references, 18 publications represented the best evidence to answer the clinical question. No randomized controlled trial addressing the three-part question was available. The authors, journal, date and country of publication, patient group, study type, relevant outcomes and results of these papers were tabulated. The studies reported on 1472 patients with different primary cancers. The patients underwent more than 1630 pulmonary metastasectomies between 1990 and 2014 after the treatment of primary cancer. Almost three quarters of patients underwent open procedures like thoracotomy or sternotomy. Most frequently, helical CT with a slice thickness ranging between 1 and 10 mm was used for preoperative imaging. The sensitivity in detecting pulmonary nodules ranged from 34 to 97%. The corresponding sensitivity rates for PET-CT were 66-67.5 and 75% for high-resolution CT. The positive predictive value for lesions detected by helical CT varied from 47 to 96%. Helical CT reached a specificity between 54 and 93% in detecting pulmonary nodules. The surgeons identified more nodules by meticulous palpation than helical CT. It is noteworthy that up to 48.5% of these palpated nodules were benign lesions (false-positive). Patients with smaller imaged nodules, multiple imaged nodules or primary mesenchymal tumour are more likely to have occult pulmonary nodules. We conclude that not all palpable pulmonary nodules can be imaged preoperatively. Thoracotomy allows the manual palpation of the ipsilateral hemithorax and might be superior to video-assisted thoracic surgery regarding radical resection. However, not all palpable nodules are malignant, and the impact of non-resected pulmonary metastases on patient survival is not clearly evaluated.

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Missed pulmonary metastasis

Abstract: Metastasectomy by an open approach, which affords bimanual palpation of the entire lung, discovered ipsilateral non-imaged malignant pulmonary metastases in 36% of cases (41% of mesenchymal tumors).

Cited by 19 publications

References 10 publications

Phase II Multicenter Clinical Trial of Pulmonary Metastasectomy and Isolated Lung Perfusion with Melphalan in Patients with Resectable Lung Metastases

Phase II Multicenter Clinical Trial of Pulmonary Metastasectomy and Isolated Lung Perfusion with Melphalan in Patients with Resectable Lung Metastases

Contribution of CAD to the Sensitivity for Detecting Lung Metastases on Thin-Section CT – A Prospective Study with Surgical and Histopathological Correlation

Is manual palpation of the lung necessary in patients undergoing pulmonary metastasectomy?: Table 1:

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