Thomas G Lesser1. 1. Department of Thoracic and Vascular Surgery, SRH Wald-Klinikum Gera, Teaching Hospital of Friedrich-Schiller-University of Jena, Gera, Germany. thomas.lesser@wkg.srh.de
Abstract
BACKGROUND: Patients with T4 non-small cell lung cancers with limited involvement of mediastinal structures can undergo resection, with acceptable long-term survival. Computed tomography has not proven to be reliable in determining the operability of locally advanced lung carcinoma. This study evaluated the ability of video-assisted thoracoscopy alone and with endothoracic sonography to determine operability. METHODS: Computed tomography showed a close contact of the tumor with mediastinal structures (T4) in 155 patients. Staging was expanded with video-assisted thoracoscopy, followed by thoracoscopic ultrasound. Lateral thoracotomy with hilar and mediastinal dissection was considered the gold standard in determining operability. RESULTS: Thoracoscopic ultrasound, compared with thoracoscopy alone and computed tomography, had the highest sensitivity (94.1% vs 75.2% vs 43.6%, p < 0.001) and specificity (98.1% vs 57.4% vs 37.0%, p < 0.001) for determining operability. Computed tomography, thoracoscopy, and thoracoscopic ultrasound were falsely negative in 57 (36.8%), 25 (16.1%), and 6 (3.9%) patients and falsely positive in 34 (21.9%), 23 (14.8%), and 1 (0.6%). False-negative results for operability by thoracoscopic ultrasound were found only in tumors involving the left atrium (3.9%). CONCLUSIONS: Estimation of operability in locally advanced lung cancer can be improved with video-assisted thoracoscopy and ultrasound. More than one-third of patients classified as inoperable by computed tomography were able to undergo complete resection. Copyright 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
BACKGROUND:Patients with T4 non-small cell lung cancers with limited involvement of mediastinal structures can undergo resection, with acceptable long-term survival. Computed tomography has not proven to be reliable in determining the operability of locally advanced lung carcinoma. This study evaluated the ability of video-assisted thoracoscopy alone and with endothoracic sonography to determine operability. METHODS: Computed tomography showed a close contact of the tumor with mediastinal structures (T4) in 155 patients. Staging was expanded with video-assisted thoracoscopy, followed by thoracoscopic ultrasound. Lateral thoracotomy with hilar and mediastinal dissection was considered the gold standard in determining operability. RESULTS: Thoracoscopic ultrasound, compared with thoracoscopy alone and computed tomography, had the highest sensitivity (94.1% vs 75.2% vs 43.6%, p < 0.001) and specificity (98.1% vs 57.4% vs 37.0%, p < 0.001) for determining operability. Computed tomography, thoracoscopy, and thoracoscopic ultrasound were falsely negative in 57 (36.8%), 25 (16.1%), and 6 (3.9%) patients and falsely positive in 34 (21.9%), 23 (14.8%), and 1 (0.6%). False-negative results for operability by thoracoscopic ultrasound were found only in tumors involving the left atrium (3.9%). CONCLUSIONS: Estimation of operability in locally advanced lung cancer can be improved with video-assisted thoracoscopy and ultrasound. More than one-third of patients classified as inoperable by computed tomography were able to undergo complete resection. Copyright 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.