title: [Minimally invasive chest surgery. Is palpation control still necessary with modern computed tomography?].
abstract: BACKGROUND
  A fundamental argument against minimally invasive oncological chest surgery is the risk of overlooking pulmonary nodules due to a lack of intraoperative palpation. In the literature this risk in the treatment of primary lung cancer is given as up to 8.4 % and as more than 15 % in the surgical treatment of pulmonary metastases.
  
  
  OBJECTIVE
  The aim of this study was to evaluate if modern computed tomography (CT) is sensitive enough to replace intraoperative palpation and justify a minimally invasive approach.
  
  
  METHODS
  The medical records from 92 patients who underwent 95 open lung resections due to pulmonary malignancies from April 2010 through September 2011 at the Medical School Hannover were retrospectively analysed. A comparison was carried out between the lesions detected preoperatively by CT and those removed during surgery and histologically confirmed as being malignant. Patients with more than five nodules suspected of being malignant in the preoperative CT scan were excluded.
  
  
  RESULTS
  According to the final histopathological examination 125 malignant nodules were resected and 2 of these were not detected in the preoperative CT scan, which were performed in external hospitals with a slice thickness of 5 mm and 8 mm, respectively. This represents a sensitivity of 98 % for all CT scans in terms of detection of pulmonary nodules. With thin slice CT (slice thickness up to 1.5 mm) a sensitivity of 100 % was even achieved.
  
  
  CONCLUSIONS
  The results demonstrate that a high sensitivity of thin slice CT for detection of lung nodules can be achieved. Based on these results the categorical reservation with respect to thoracoscopic resection of pulmonary metastases should be reconsidered in suitable patients where a minimally invasive resection is possible. The extent of lymph node dissection is not influenced by these data. Further studies with larger sample sizes are warranted to confirm these results.
authors.affiliation: Klinik für Herz-, Transplantations-, Thorax- und Gefäßchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland. Krueger.Marcus@mh-hannover.de.
authors.forename: M
authors.initials: M
authors.lastname: Krüger
authors.affiliation: Klinik für Herz-, Transplantations-, Thorax- und Gefäßchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
authors.forename: N
authors.initials: N
authors.lastname: Zinne
authors.affiliation: Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, 30625, Hannover, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Shin
authors.affiliation: Klinik für Herz-, Transplantations-, Thorax- und Gefäßchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Klinik für Herz-, Transplantations-, Thorax- und Gefäßchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Biancosino
authors.affiliation: Klinik für Herz-, Transplantations-, Thorax- und Gefäßchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
authors.forename: I
authors.initials: I
authors.lastname: Kropivnitskaja
authors.affiliation: Institut für Pathologie, Medizinische Hochschule Hannover, 30625, Hannover, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Länger
authors.affiliation: Klinik für Herz-, Transplantations-, Thorax- und Gefäßchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Haverich
authors.affiliation: Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, 30625, Hannover, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Dettmer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D010173:Palpation / Q000379:methods*; D011013:Pneumonectomy; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Computed tomography; Computer assisted detection; Lung cancer; Lung metastasis; Video assisted thorascopic surgery