Go Kamimura1,2, Kazuhiro Ueda2, Soichi Suzuki2, Koki Maeda2, Hiroto Hakamada3, Masami Sato2. 1. Department of General Thoracic Surgery, Nanphu Hospital, Kagosima, Japan. 2. Department of Radiology, Nanphu Hospital, Kagosima, Japan. 3. Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Abstract
BACKGROUND: During sublobar resection for small, indistinct lung cancer, surgeons may be uncertain as to whether or not the target lesion has been resected and the surgical margin is sufficient. We herein report our procedure for confirming the success of sublobar resection without incising the resected specimen. METHODS: We reviewed our initial experience of 12 patients with intrapulmonary lesions (consolidation diameter ≤1 cm) who underwent thoracoscopic pulmonary wedge resection using autostapler. Six patients had primary adenocarcinoma showing part solid lesion, and remaining six patients had metastatic carcinoma showing purely solid lesion. Intraoperatively, the resected specimen was inflated with air and subjected to computed tomography (CT). The maximum tumor diameter and surgical margin length were measured intraoperatively on CT and postoperatively on formalin-fixed specimen. Surgical stump cytology was also done to verify surgical margin. RESULTS: According to the intraoperative CT, complete resection was confirmed in all patients. The intraoperative CT-based maximum tumor diameter closely correlated with the macroscopically measured one (r=0.971, P<0.0001). However, the tumor shrunk after formalin-fixation by 16.0% in patients with primary lung cancer (P<0.01), but not in patients with metastatic lung cancer. The intraoperative CT-based margin length closely correlated with the macroscopically measured one (r=0.984, P<0.0001). However, the margin shrunk after formalin-fixation in both patients with primary lung cancer and metastatic lung cancer, by 15.1% and 15.7%, respectively. Stump cytology was negative in all patients. Consequently, no recurrence was found during postoperative follow-up of 23 months (range, 14-31 months). CONCLUSIONS: Intraoperative CT is reliable for diagnosing the presence of a target lesion within the resected specimen as well as for estimating the surgical margin length in patients undergoing sublobar resection for intrapulmonary indistinct lesions. 2022 Quantitative Imaging in Medicine and Surgery. All rights reserved.
BACKGROUND: During sublobar resection for small, indistinct lung cancer, surgeons may be uncertain as to whether or not the target lesion has been resected and the surgical margin is sufficient. We herein report our procedure for confirming the success of sublobar resection without incising the resected specimen. METHODS: We reviewed our initial experience of 12 patients with intrapulmonary lesions (consolidation diameter ≤1 cm) who underwent thoracoscopic pulmonary wedge resection using autostapler. Six patients had primary adenocarcinoma showing part solid lesion, and remaining six patients had metastatic carcinoma showing purely solid lesion. Intraoperatively, the resected specimen was inflated with air and subjected to computed tomography (CT). The maximum tumor diameter and surgical margin length were measured intraoperatively on CT and postoperatively on formalin-fixed specimen. Surgical stump cytology was also done to verify surgical margin. RESULTS: According to the intraoperative CT, complete resection was confirmed in all patients. The intraoperative CT-based maximum tumor diameter closely correlated with the macroscopically measured one (r=0.971, P<0.0001). However, the tumor shrunk after formalin-fixation by 16.0% in patients with primary lung cancer (P<0.01), but not in patients with metastatic lung cancer. The intraoperative CT-based margin length closely correlated with the macroscopically measured one (r=0.984, P<0.0001). However, the margin shrunk after formalin-fixation in both patients with primary lung cancer and metastatic lung cancer, by 15.1% and 15.7%, respectively. Stump cytology was negative in all patients. Consequently, no recurrence was found during postoperative follow-up of 23 months (range, 14-31 months). CONCLUSIONS: Intraoperative CT is reliable for diagnosing the presence of a target lesion within the resected specimen as well as for estimating the surgical margin length in patients undergoing sublobar resection for intrapulmonary indistinct lesions. 2022 Quantitative Imaging in Medicine and Surgery. All rights reserved.
Authors: Fabian M Troschel; Ravi V Gottumukkala; Daniel DiCorpo; Julia Mario; Harald C Ott; Cameron D Wright; Ashok Muniappan; Michael Lanuti; Kai Yang; JoAnne O Shepard; Valentina Nardi; James S Michaelson; Lida P Hariri; Florian J Fintelmann Journal: Arch Pathol Lab Med Date: 2018-11-20 Impact factor: 5.534