[The preoperative multislice spiral CT in the surgical management of pulmonary metastases].
BACKGROUND
Inspection and palpation of the ventilated and exhausted lung reflect the guideline-compliant surgery of pulmonary metastases. Because a huge number of pulmonary nodules are missed on preoperative CT, metastases must be diagnosed by the surgeon's examination of the lung under exclusion of the video-assisted approach. The purpose of our study was to assess whether a special multislice (MS) spiral CT may close this diagnostic gap and change the management of pulmonary surgery.


METHODS
We performed a prospective study to address this question. Operative and histological results of 60 patients with pulmonary nodules (7/2002 and 12/2004) were compared with the preoperative predictions of MS-CT.


RESULTS
In 81 operations, 166 pulmonary metastases were confirmed histologically. The MS-CT predicted 229 suspicious metastases; 38% could not be confirmed histologically. However, in 14% of surgically confirmed metastases the radiological correlate was absent. 44% of these metastases were <or=2 mm, 30%<or=4 mm, and 26%>4 mm; and were from the following primary entities: 48% hypernephroma, 30% sarcoma, 17% colorectal carcinoma and 4% breast cancer. The radiological prediction of 1 to 3 vs. 5 to 11 metastases implied 30% vs. 70% additional filiae, whereas radiologically non-described metastases were found in 12% of all operations. In contrast, the group with radiopaque material showed only 5% of metastases without a radiological correlate or 8% of non-described metastases. The overall sensitivity of MS-CT was 86%, whereas the group with radiopaque material had a sensitivity of 95%.


CONCLUSIONS
The preoperative MS-CT does not resolve the problem of overlooked metastases and has no influence on the management of pulmonary surgery.
Schneider
R
R
Klinik für Viszeral-, Thorax-, Transplantations- und Gefässchirurgie der Universität Leipzig, Leipzig. Rick.Schneider@medizin.uni-leipzig.de
Leinung
S
S
Klöppel
R
R
Kahn
T
T
Dieckmann
T
T
Eichfeld
U
U
D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000601:surgery; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003287:Contrast Media / Q000008:administration & dosage; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000601:surgery; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D036542:Tomography, Spiral Computed
D003287:Contrast Media