title: Accuracy of transthoracic ultrasound for the prediction of chest wall infiltration by lung cancer and of lung infiltration by chest wall tumours.
abstract: BACKGROUND
  We wanted to determine the accuracy of transthoracic ultrasound in the prediction of chest wall infiltration by lung cancer or lung infiltration by chest wall tumours.
  
  
  METHODS
  Patients having preoperative CT-scan suspect for lung/chest wall infiltration were prospectively enrolled. Inclusion criteria for lung cancer were: obliteration of extrapleural fat, obtuse angle between tumour and chest wall, associated pleural thickening. The criteria for chest wall tumours were: rib destruction and intercostal muscles infiltration with extrapleural fat obliteration and intrathoracic extension. Lung cancer patients with evident chest wall infiltration were excluded. Transthoracic ultrasound was preoperatively performed. Predictions were checked during surgical intervention.
  
  
  RESULTS
  Twenty-three patients were preoperatively examined. Sensitivity, specificity, positive and negative predictive values of transthoracic ultrasound were 88.89%, 100%, 100% and 93.3%, respectively. Youden index was used to determine the best cut-off for tumour size in predicting lung/chest wall infiltration: 4.5cm. At univariate logistic regression, tumour size (<4.5 vs ≥ 4.5cm) (p=0.0072) was significantly associated with infiltration.
  
  
  CONCLUSIONS
  Transthoracic ultrasound is a useful instrument for predicting neoplastic lung or chest wall infiltration in cases of suspect CT-scans and could be used as part of the preoperative workup to assess tumour staging and to plan the best surgical approach.
authors.affiliation: Thoracic Surgery Unit, S.Orsola - Malpighi Hospital, Bologna, Italy. Electronic address: caroli.guido@gmail.com.
authors.forename: Guido
authors.initials: G
authors.lastname: Caroli
authors.affiliation: Thoracic Surgery Unit, S.Orsola - Malpighi Hospital, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Dell'Amore
authors.affiliation: Thoracic Surgery Unit, AOUI - Verona, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Cassanelli
authors.affiliation: Thoracic Surgery Unit, S.Orsola - Malpighi Hospital, Bologna, Italy.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Dolci
authors.affiliation: Local Health Authority, Public Health Department, San Lazzaro di Savena, Bologna, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Pipitone
authors.affiliation: Thoracic Surgery Unit, AOUI - Verona, Italy.
authors.forename: Nizar
authors.initials: N
authors.lastname: Asadi
authors.affiliation: Thoracic Surgery Unit, S.Orsola - Malpighi Hospital, Bologna, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Stella
authors.affiliation: Thoracic Surgery Unit, S.Orsola - Malpighi Hospital, Bologna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bini
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D002812:Chondroma / Q000000981:diagnostic imaging* / Q000601:surgery; D002813:Chondrosarcoma / Q000000981:diagnostic imaging* / Q000601:surgery; D003110:Colonic Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D007366:Intercostal Muscles / Q000000981:diagnostic imaging; D007680:Kidney Neoplasms / Q000473:pathology*; D008080:Liposarcoma / Q000000981:diagnostic imaging* / Q000601:surgery; D008168:Lung / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010051:Ovarian Neoplasms / Q000473:pathology*; D010994:Pleura / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D012186:Retroperitoneal Neoplasms / Q000473:pathology*; D012272:Ribs / Q000000981:diagnostic imaging; D013899:Thoracic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D035441:Thoracic Wall / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D014463:Ultrasonography
keywords: Chest wall; Chest wall surgery; Computed Tomography; Lung cancer diagnosis; Lung cancer surgery; Ultrasound