title: Preoperative imaging of pulmonary metastases in patients with melanoma: implications for minimally invasive techniques.
abstract: OBJECTIVE
  Preoperative imaging underestimates the number of pulmonary melanoma metastases. Although thoracoscopic resection is less invasive than resection via thoracotomy, it does not allow manual palpation of the lung to identify any metastases not visible on the preoperative scan or at the time of resection.
  
  
  METHODS
  Retrospective review of a prospectively maintained database.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  A total of 170 patients who underwent preoperative computed tomography of the chest, followed within 30 days by thoracotomy for resection of pulmonary metastatic melanoma.
  
  
  METHODS
  Number of pathology-confirmed pulmonary metastases detected by preoperative chest computed tomography vs intraoperative manual palpation.
  
  
  RESULTS
  The mean age of the patients was 49.5 years at initial diagnosis of melanoma and 57.1 years at diagnosis of pulmonary metastases; 69% of patients were male. A total of 334 pulmonary metastases were resected; the mean lesion size was 2.0 cm (range, 0.1-14.0 cm). In 49 of 190 pulmonary resections (26%), manual palpation of the subpleural parenchyma revealed lesions not identified during preoperative imaging. The rate of 5-year overall survival was 33%.
  
  
  CONCLUSIONS
  Preoperative imaging underestimates the number of pulmonary lesions in patients with metastatic melanoma. Because incomplete resection of metastatic disease is associated with worse outcomes, we recommend caution when considering a minimally invasive approach for the resection of pulmonary metastatic melanoma.
authors.affiliation: Department of Surgical Oncology, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA 90404, USA.
authors.forename: Travis B
authors.initials: TB
authors.lastname: Kidner
authors.forename: Jeong
authors.initials: J
authors.lastname: Yoon
authors.forename: Mark B
authors.initials: MB
authors.lastname: Faries
authors.forename: Donald L
authors.initials: DL
authors.lastname: Morton
mesh_terms: D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery*; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011013:Pneumonectomy / Q000379:methods*; D011300:Preoperative Care; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed