Video-Assisted Thoracoscopic Surgery for Small Indeterminate Pulmonary Nodules

医学 结核(地质) 开胸手术 放射科 电视胸腔镜手术 胸片 回顾性队列研究 胸腔镜检查 单变量分析 逻辑回归 多元分析 肺孤立结节 心胸外科 不确定 外科 射线照相术 内科学 计算机断层摄影术 古生物学 数学 纯数学 生物
作者
Mitsuhiro Fujii,Kazuyuki Nagai,Junji Yoshida,Hironobu Ohmatsu,Katsuya Takahashi,Masaharu Nishimura,Y Nishiwaki
出处
期刊:Chest [Elsevier BV]
卷期号:115 (2): 563-568 被引量:418
标识
DOI:10.1378/chest.115.2.563
摘要

Study objective To determine the indications for preoperative localization of a small indeterminate pulmonary nodule. Design In this retrospective study, univariate and multivariate analyses were performed by the logistic regression procedure. Setting A single National Cancer Center Hospital in Japan. Patients A series of 92 consecutive patients who underwent video-assisted thoracoscopic surgery (VATS) at our institute between 1993 and 1996. Interventions The frequency and reasons for conversion to thoracotomy were assessed retrospectively. All preoperative CT scans were reviewed for eight radiologic features by two of the authors. These data were entered into univariate and multivariate analyses to identify the significant risk factors for a failure to detect a pulmonary nodule. Measurements and results Fifty patients (54%) needed conversion to a thoracotomy. The most common reason for the conversion was failure to localize nodules (46%). Univariate and multivariate analyses of 11 variables revealed one significant risk factor in the failure to detect nodules: distance to the nearest pleural surface (p < 0.05). Tumor size on radiograph remained marginally significant (p = 0.065) in multivariate analyses. If the distance to the pleural surface was > 5 mm in cases of nodules ≤ 10 mm in size, the probability of failure to detect a nodule was 63%. Conclusions Our results suggested the indications for preoperative localization of a peripheral pulmonary nodule. Preoperative marking for a small indeterminate pulmonary nodule should be considered when the distance to the nearest pleural surface is > 5 mm in cases of lung nodules of≤ 10 mm in size. To determine the indications for preoperative localization of a small indeterminate pulmonary nodule. In this retrospective study, univariate and multivariate analyses were performed by the logistic regression procedure. A single National Cancer Center Hospital in Japan. A series of 92 consecutive patients who underwent video-assisted thoracoscopic surgery (VATS) at our institute between 1993 and 1996. The frequency and reasons for conversion to thoracotomy were assessed retrospectively. All preoperative CT scans were reviewed for eight radiologic features by two of the authors. These data were entered into univariate and multivariate analyses to identify the significant risk factors for a failure to detect a pulmonary nodule. Fifty patients (54%) needed conversion to a thoracotomy. The most common reason for the conversion was failure to localize nodules (46%). Univariate and multivariate analyses of 11 variables revealed one significant risk factor in the failure to detect nodules: distance to the nearest pleural surface (p < 0.05). Tumor size on radiograph remained marginally significant (p = 0.065) in multivariate analyses. If the distance to the pleural surface was > 5 mm in cases of nodules ≤ 10 mm in size, the probability of failure to detect a nodule was 63%. Our results suggested the indications for preoperative localization of a peripheral pulmonary nodule. Preoperative marking for a small indeterminate pulmonary nodule should be considered when the distance to the nearest pleural surface is > 5 mm in cases of lung nodules of≤ 10 mm in size.
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