title: Prediction of lung tumor palpability using high-resolution computed tomography.
abstract: BACKGROUND
  Palpation is the most important means of locating lung tumors and resecting them with sufficient margins. This study aimed to predict the palpability of pulmonary lesions using high-resolution computed tomography.
  
  
  METHODS
  Eighty-six pulmonary lesions were palpated in fresh resected lung specimens from July 2013 to March 2014. The following parameters were compared between 10 impalpable and 76 palpable lesions: maximum tumor size in pulmonary and bone window level settings, consolidation tumor size in pulmonary window level setting, and pleural-tumor distance. In 54 adenocarcinomas, the lepidic component and fibrosis foci rates were compared between the two groups.
  
  
  RESULTS
  Tumor size in bone window level setting and the consolidation tumor size were significantly smaller in the impalpable group (both p < 0.001), and an operational cutoff of 5 mm was identified by receiver-operating characteristic analysis (sensitivity/specificity was 90.0%/94.7% and 90.0%/86.9%, respectively). Pulmonary lesions were impalpable with 87.5% probability when the tumor size in bone window level setting was ≤ 5 mm and the pleural-tumor distance was ≥ 5 mm, and with 85.7% probability when the consolidation tumor size was ≤ 5 mm and the pleural-tumor distance was ≥ 5 mm. Lepidic component and fibrosis foci rates of impalpable/palpable lesions were 96.0%/52.8% and 4.0%/24.7%, respectively (both p < 0.001).
  
  
  CONCLUSIONS
  Tumor size in bone window level setting or a consolidation tumor size ≤ 5 mm and pleural-tumor distance ≥ 5 mm are simple criteria that are potentially useful indicators for preoperative marking to locate small-sized lepidic-predominant adenocarcinomas with few fibrotic foci.
authors.affiliation: Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan Department of Surgery, Yokohama City University, Yokohama, Japan l401092k@yahoo.co.jp.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Isaka
authors.affiliation: Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ito
authors.affiliation: Department of Pathology, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yokose
authors.affiliation: Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kondo
authors.affiliation: Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Nagata
authors.affiliation: Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Nishii
authors.affiliation: Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Kouzo
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Nakayama
authors.affiliation: Department of Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000077192:Adenocarcinoma of Lung; D000368:Aged; D059925:Anatomic Landmarks; D019540:Area Under Curve; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010173:Palpation; D011013:Pneumonectomy / Q000379:methods; D011237:Predictive Value of Tests; D012372:ROC Curve; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden
keywords: Adenocarcinoma; Fibrosis; Lung neoplasms; Palpation; Thoracic surgery; Tomography; X-ray computed; bronchiolo-alveolar; video-assisted