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CT assessment-based direct surgical resection of part-solid nodules with solid component larger than 5 mm without preoperative biopsy: experience at a single tertiary hospital

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Abstract

Objectives

To retrospectively evaluate the feasibility of CT assessment-based direct surgical resection of part-solid nodules (PSNs) with solid components > 5 mm without preoperative percutaneous transthoracic needle biopsies (PTNBs).

Methods

From January 2009–December 2014, 85 PSNs with solid components > 5 mm on CT were included. Preoperative PTNBs were performed for 41 PSNs (biopsy group) and CT assessment-based direct resections were performed for 44 PSNs (direct surgery group). Diagnostic accuracy and complication rates of the groups were compared.

Results

Pathological results of 83 PSNs excluding two indeterminate nodules included 76 adenocarcinomas (91.6%), two adenocarcinomas in situ (2.4%) and five benign lesions (6.0%). In the biopsy group, the overall sensitivity, specificity and accuracy for the diagnosis of adenocarcinoma were 78.9% (30/38), 100% (1/1) and 79.5% (31/39), respectively. Pneumothorax and haemoptysis occurred in 11 procedures (26.8%). In the direct surgery group, the respective values for the diagnosis of adenocarcinoma were 100% (38/38), 0% (0/6) and 86.4% (38/44), respectively. Seven pneumothoraces (15.9%); no haemoptysis occurred during localization procedures. There were no significant differences in diagnostic accuracy (P = 0.559) between the two groups.

Conclusions

CT assessment-based direct resection can be reasonable for PSNs with solid part > 5 mm.

Key points

• 91.6% of PSNs with solid component > 5 mm were adenocarcinomas.

• PTNBs for PSNs with solid component > 5 mm had 79.5% accuracy.

• CT-based resection for PSNs with solid component > 5 mm had 86.4% accuracy.

• CT-based resection without biopsy can be a reasonable option in routine practice.

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Abbreviations

CBCT:

Cone beam CT

DAP:

Dose area product

GGN:

Ground-glass nodule

GGO:

Ground-glass opacity

PSNs:

Part-solid nodules

PTNB:

Percutaneous thoracic needle biopsy

SSNs:

Subsolid nodules

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Author information

Author notes

  1. Sang Min Lee

    Present address: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

Authors and Affiliations

  1. Department of Radiology, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul, 110-744, South Korea

    Sang Min Lee, Chang Min Park, Yong Sub Song, Hyungjin Kim & Jin Mo Goo

  2. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea

    Sang Min Lee, Chang Min Park, Yong Sub Song, Hyungjin Kim & Jin Mo Goo

  3. Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea

    Young Tae Kim

  4. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea

    Young Sik Park

  5. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

    Young Sik Park

Authors
  1. Sang Min Lee
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  2. Chang Min Park
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  3. Yong Sub Song
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  4. Hyungjin Kim
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  7. Jin Mo Goo
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Corresponding author

Correspondence to Chang Min Park.

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Guarantor

The scientific guarantor of this publication is Dr. Chang Min Park.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

This research was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (grant number: HC15C3390).

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Of 86 lesions, 57 were identical to the study population in the previous reports (41 lesions in Lee et al. [13] and 16 lesions in Kim et al. [15]. Lee et al.’s study dealt with the diagnostic performance and complications of CBCT-guided PTNB in a large population and Kim et al.’s study addressed the accuracy and safety of CBCT-guided percutaneous transthoracic localization, whereas this work focused on pathological results of PSNs with a solid component larger than 5 mm on CT and evaluation of the feasibility of CT assessment-based direct surgical resection in comparison to PTNB. Thus, this work is substantially different from previous reports.

Methodology

• retrospective

• observational

• performed at one institution

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Lee, S.M., Park, C.M., Song, Y.S. et al. CT assessment-based direct surgical resection of part-solid nodules with solid component larger than 5 mm without preoperative biopsy: experience at a single tertiary hospital. Eur Radiol 27, 5119–5126 (2017). https://doi.org/10.1007/s00330-017-4917-6

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  • DOI: https://doi.org/10.1007/s00330-017-4917-6

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