Preoperative detection of pleural adhesions using dynamic chest radiography: prospective analysis

Abstract

Background: To plan a surgical approach and predict the operative time or bleeding volume, it is important to determine the presence of pleural adhesions before surgery. Dynamic chest radiography (DCR)is a new modality that can dynamically capture X-rays, and we assessed the utility of DCR for detecting pleural adhesions preoperatively. Methods:The subjects of this study were those who underwent DCR before surgery from January 2020 to May 2022. The preoperative evaluation was performed by three imaging analysis modes, and pleural adhesion was defined as the that spreading to more than 20% of the thoracic cavity and/or taking more than 5 minutes to dissect.Results: Of the 120 total patients, DCR was performed properly for 119 (99.2%). Accurate preoperative evaluations of pleural adhesions were confirmed in 101 patients (84.9%), with a sensitivity of 64.5%, specificity of 91.0%, positive predictive value of 74.1%, and negative predictive value of 88.0%.Conclusions: DCR was very easy to perform in all preoperative patients with all manner of thoracic disease. We demonstrated the utility of DCR, showing its high specificity and negative predictive value.DCR has the potential to become a common preoperative examination for detecting pleural adhesions with further improvements in software programs.

One size does not fit all: prediction of presence of pleural adhesions

“…Various classifications have been used in literature based on the presentation of the pleural adhesions (e.g., density, coverage) ( 1 ) and the degree of surgical disturbance ( 6 ). In the work of Watanabe and colleagues, the presence of pleural adhesion was confirmed with intraoperative findings: the coverage of more than 20% of the thoracic cavity and/or dissection time of more than 5 minutes ( 11 ). The criteria include the aspects of the presentation and surgical disturbance, elaboration of the determination of the cut-off value is expected for future reference.…”

“…A recent study by Watanabe et al investigated the utility of dynamic chest radiography (DCR) in detecting pleural adhesions ( 11 ). DCR is a relatively new X-ray imaging modality for analyzing and diagnosing chronic obstructive pulmonary disease, cystic fibrosis, and pulmonary hypertension.…”

“…In cases with peripheral lung cancer, analysis by 4D or respiratory dynamic CT may be applicable for the evaluation of pleural invasion as well as ultrasonography in cases with peripheral lung cancer ( 6 , 7 ). Watanabe and colleagues examined DCR mainly from the perspectives of the patient-by-patient analysis aiming to estimate operative time and bleeding volume ( 11 ). Regarding the lesion-by-lesion analysis, although LMA may suggest approximate adhesion sites (e.g., apex, lower lung field), the localization of adhesion only with frontal chest radiography seems to be challenging.…”

Potential of dynamic chest radiography for preoperative evaluation of pleural adhesions

“…In a study published in a previous issue of the Journal of Thoracic Disease , Watanabe et al reported on the diagnostic efficacy of DCR for pleural adhesions ( 15 ). The most substantial novelty of this study is its evaluation of the diagnostic ability of DCR, particularly the LM mode.…”

“…In a previous study using the FE mode of DCR, pleural adhesions were evaluated on the basis of three abnormal motions (restricted motion, structural tension, and distorted motion) ( 16 ). However, this method is subjective, as the results depend on the skill of the evaluator ( 15 ).…”