[Usefulness of video-assisted thoracoscopy for correctly staging tumors as T3 because of chest wall invasion].
BACKGROUND
Exploratory video-assisted thoracoscopy (EVT) can be used to assess the resectability of lung carcinomas. The aim of this study was to investigate the usefulness of this technique for distinguishing between tumors that invade the chest wall and should be staged as T3 and tumors that have been incorrectly staged as T3 on the basis of imaging studies.


METHODS
From March 1993 through December 2007, we studied 1277 patients, of whom 150 (137 men and 13 women; age range, 28-81 years) presented tumors classified as cT3 because of chest wall invasion on the basis of imaging studies.


RESULTS
After exploratory EVT, 44 pT3 tumors with chest wall invasion were confirmed intraoperatively and by histopathology. Of these, 36 had been correctly classified as cT3 by computed tomography or magnetic resonance imaging. However, tumors had been understaged as cT2 in 6 patients and overstaged as cT4 in 2 patients. The sensitivity, specificity, and positive and negative predictive values obtained were 100%.


CONCLUSIONS
We believe that exploratory EVT is clearly better than computed tomography and/or magnetic resonance imaging for detecting chest wall invasion. In addition to correctly staging a tumor as T3 because of chest wall invasion, the technique can also help decide the best surgical approach in each case.
Gallardo-Valera
Gregorio
G
Servicio de Cirugía General y Torácica, Hospital Universitario Virgen Macarena, Sevilla, España.
Triviño-Ramírez
Ana
A
Congregado
Miguel
M
Jiménez-Merchán
Rafael
R
Ayarra Jarné
Francisco Javier
FJ
Loscertales
Jesús
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging / Q000379:methods*; D010994:Pleura / Q000000981:diagnostic imaging / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012272:Ribs / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D055752:Small Cell Lung Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D020775:Thoracic Surgery, Video-Assisted; D035441:Thoracic Wall / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed