title: Preoperative (3-dimensional) computed tomography lung reconstruction before anatomic segmentectomy or lobectomy for stage I non-small cell lung cancer.
abstract: OBJECTIVE
  Accurate cancer localization and negative resection margins are necessary for successful segmentectomy. In this study, we evaluate a newly developed software package that permits automated segmentation of the pulmonary parenchyma, allowing 3-dimensional assessment of tumor size, location, and estimates of surgical margins.
  
  
  METHODS
  A pilot study using a newly developed 3-dimensional computed tomography analytic software package was performed to retrospectively evaluate preoperative computed tomography images of patients who underwent segmentectomy (n = 36) or lobectomy (n = 15) for stage 1 non-small cell lung cancer. The software accomplishes an automated reconstruction of anatomic pulmonary segments of the lung based on bronchial arborization. Estimates of anticipated surgical margins and pulmonary segmental volume were made on the basis of 3-dimensional reconstruction.
  
  
  RESULTS
  Autosegmentation was achieved in 72.7% (32/44) of preoperative computed tomography images with slice thicknesses of 3 mm or less. Reasons for segmentation failure included local severe emphysema or pneumonitis, and lower computed tomography resolution. Tumor segmental localization was achieved in all autosegmented studies. The 3-dimensional computed tomography analysis provided a positive predictive value of 87% in predicting a marginal clearance greater than 1 cm and a 75% positive predictive value in predicting a margin to tumor diameter ratio greater than 1 in relation to the surgical pathology assessment.
  
  
  CONCLUSIONS
  This preoperative 3-dimensional computed tomography analysis of segmental anatomy can confirm the tumor location within an anatomic segment and aid in predicting surgical margins. This 3-dimensional computed tomography information may assist in the preoperative assessment regarding the suitability of segmentectomy for peripheral lung cancers.
authors: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors: Ernest G
authors: EG
authors: Chan
authors: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors: James R
authors: JR
authors: Landreneau
authors: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa. Electronic address: schuchertmj@upmc.edu.
authors: Matthew J
authors: MJ
authors: Schuchert
authors: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors: David D
authors: DD
authors: Odell
authors: Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors: Suicheng
authors: S
authors: Gu
authors: Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors: Jiantao
authors: J
authors: Pu
authors: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors: James D
authors: JD
authors: Luketich
authors: Department of Cardiothoracic Surgery, Allegheny Health Network, Pittsburgh, Pa.
authors: Rodney J
authors: RJ
authors: Landreneau
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D018579:Patient Selection; D010865:Pilot Projects; D011013:Pneumonectomy / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D012189:Retrospective Studies; D012984:Software; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: computed tomography; lung cancer; lung reconstruction; segmentectomy