title: Ex vivo pulmonary nodule detection with miniaturized ultrasound convex probes.
abstract: BACKGROUND
  The intraoperative localization of small and deep pulmonary nodules is often difficult during minimally invasive thoracic surgery. We compared the performance of three miniaturized ultrasound (US) convex probes, one of which is currently used for thoracic endoscopic diagnostic procedures, for the detection of lung nodules in an ex vivo lung perfusion model.
  
  
  METHODS
  Three porcine cardiopulmonary blocks were perfused, preserved at 4°C for 6 h and reconditioned. Lungs were randomly seeded with different patterns of echogenicity target nodules (9 water balls, 10 fat, and 11 muscles; total n = 30). Three micro-convex US probes were assessed in an open setting on the pleural surface: PROBE 1, endobronchial US 5-10 MHz; PROBE 2, laparoscopic 4-13 MHz; PROBE 3, fingertip micro-convex probe 5-10 MHz. US probes were evaluated regarding the number of nodules localized/not localized, the correlation between US and open specimen measurements, and imaging quality.
  
  
  RESULTS
  For detecting target nodules, the sensitivity was 100% for PROBE 1, 86.6% for PROBE 2, and 78.1% for PROBE 3. A closer correlation between US and open specimen measurements of target diameter (r = 0.87; P = 0.0001) and intrapulmonary depth (r = 0.97; P = 0.0001) was calculated for PROBE 1 than for PROBES 2 and 3. The imaging quality was significantly higher for PROBE 1 than for PROBES 2 and 3 (P < 0.04).
  
  
  CONCLUSIONS
  US examination with micro-convex probes to detect pulmonary nodules is feasible in an ex vivo lung perfusion model. PROBE 1 achieved the best performance. Clinical research with the endobronchial US micro-convex probe during minimally invasive thoracic surgery is advisable.
authors.affiliation: Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Daddi
authors.affiliation: Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; Division of Internal Medicine, University of Bologna, Bologna, Italy; PhD Course in Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Sagrini
authors.affiliation: Division of Thoracic Surgery, Maria Cecilia Hospital-GVM Care and Research, Cotignola, Ravenna, Italy.
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Lugaresi
authors.affiliation: Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; Division of Internal Medicine, University of Bologna, Bologna, Italy; PhD Course in Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: Ottorino
authors.initials: O
authors.lastname: Perrone
authors.affiliation: Division of Pneumology, AUSL Ravenna, Area Vasta Romagna, Ravenna, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Candoli
authors.affiliation: Thoracic Surgery Unit, Department of Surgical-Biomedical Sciences, University of Perugia, Perugia, Italy.
authors.forename: Mark
authors.initials: M
authors.lastname: Ragusa
authors.affiliation: Thoracic Surgery Unit, Department of Surgical-Biomedical Sciences, University of Perugia, Perugia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Puma
authors.affiliation: Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; PhD Course in Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Division of Thoracic Surgery, Maria Cecilia Hospital-GVM Care and Research, Cotignola, Ravenna, Italy. Electronic address: sandro.mattioli@unibo.it.
authors.forename: Sandro
authors.initials: S
authors.lastname: Mattioli
mesh_terms: D000818:Animals; D066298:In Vitro Techniques; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D012680:Sensitivity and Specificity; D013552:Swine; D020775:Thoracic Surgery, Video-Assisted; D018084:Ultrasonography, Interventional / Q000295:instrumentation*
keywords: Endobronchial ultrasound probe; Ex vivo lung perfusion; Finger probe; In vitro simulation; Lung nodule; Microconvex probe; Ultrasound