A 20-year retrospective analysis of CT-based pre-operative identification of pulmonary metastases in patients with osteosarcoma: A single-center review.
OBJECTIVE
Cooperative studies support complete metastasectomy in osteosarcoma (OS). Pre-operative CT is used to identify and quantify metastases and can facilitate minimally invasive techniques. Here we assess the accuracy of pre-operative CT compared to findings at thoracotomy and its change over time.


METHODS
We reviewed OS thoracotomies performed at our institution from 1996 to 2015. The number of metastases identified on pre-operative chest CT was compared to the number of metastases seen on pathology (both metastases with viable cells and non-viable, osteoid-only metastases).


RESULTS
Eighty-eight patients underwent 161 thoracotomies with a median of 14days (range, 1-85) between CT and surgery, a median of 2 CT-identified lesions (range, 0-15), and a median of 4 resected lesions (range, 1-25). In 56 (34.8%) cases, more metastases were found surgically than were seen on CT, and among these, 34 (21.1%) had a greater number of viable metastases. There was poor overall correlation between CT and pathology findings (Kendall Tau-b=0.506), regardless of CT slice thickness, decade of thoracotomy, or total number of CT-identified lesions.


CONCLUSIONS
CT accuracy in pre-operatively quantifying OS pulmonary metastases has not improved in recent decades. Consequently, we recommend an open technique with direct lung palpation for complete identification and resection of OS pulmonary metastases.


METHODS
Level IV, retrospective study with no comparison group.
Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: heatont@mskcc.org.
Todd E
TE
Heaton
Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
William J
WJ
Hammond
Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Benjamin A
BA
Farber
Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Valerie
V
Pallos
Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY.
Paul A
PA
Meyers
Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY.
Alexander J
AJ
Chou
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
Anita P
AP
Price
Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Michael P
MP
LaQuaglia
D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D008168:Lung / Q000601:surgery; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D008297:Male; D059146:Metastasectomy; D012516:Osteosarcoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D010173:Palpation; D012189:Retrospective Studies; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D055815:Young Adult
Metastasectomy; Osteosarcoma; Pediatric surgery; Pulmonary metastasis; Thoracotomy