Abstract
Objective
To evaluate the use of a small mobile ultrasound probe to localize small lung tumors during thoracoscopic surgery under thoracic CO2 insufflation.
Methods
We prospectively enrolled 20 patients (26 tumors) scheduled to undergo thoracoscopic pulmonary wedge resection between April 2016 and October 2018. Ultrasonographic tumor detection was performed with an ARIETTA 850 and L51K probe (Hitachi, Tokyo, Japan). Ultrasonography was repeated after achieving adequate lung collapse under a positive intrathoracic pressure of 8–15 mmHg. The appearance on preoperative CT versus the ultrasonographic localization was compared for each tumor. The receiver operating characteristic curves were compared for the tumor dimension of the lung window, consolidation dimension of the lung window, tumor dimension of the mediastinal window (MD), and tumor depth from the lung surface.
Results
The average age was 62 years (range 42–79 years), average pathological tumor size was 9 mm (range 3–22 mm), and average tumor depth was 6 mm (range 1–25 mm). Although no tumors could be visualized before lung collapse, 22 tumors (85%) were detectable with ultrasonography after lung collapse. Of these 22 tumors, 16 were well-depicted, while six were poorly delineated. MD showed the largest area under the receiver operating characteristic curve (0.81), and tumors with a MD of ≤ 6 mm had a high risk of difficult localization using ultrasonography.
Conclusion
This ultrasonographic method obtained high tumor detection rates, especially for tumors with a MD > 6 mm. Tumors with a MD ≤ 6 mm may require another localization method.
Clinical registration number
University Hospital Medical Information Network Clinical Trials Registry (UMIN000036921).
Similar content being viewed by others
Abbreviations
- CT:
-
Computed tomography (CT)
- VATS:
-
Video-assisted thoracoscopic surgery (VATS)
- ROC:
-
Receiver operating characteristic (ROC)
- LD:
-
Tumor dimension in the lung window (LD)
- CD:
-
Consolidation dimension of the tumor in the lung window (CD)
- MD:
-
Tumor dimension in the mediastinal window (MD)
- GD:
-
Good depiction
- UD:
-
Unclear depiction
- NV:
-
Non-visible
References
Dendo S, Kanazawa S, Ando A, Hyodo T, Kouno Y, Yasui K, et al. Preoperative localization of small pulmonary lesions with a short hook wire and suture system: experience with 168 procedures. Radiology [Internet]. 2002 [cited 2020 May 17];225:511–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12409589
Ichinose J, Kohno T, Fujimori S, Harano T, Suzuki S. Efficacy and complications of computed tomography-guided hook wire localization. Ann Thorac Surg [Internet]. 2013;96:1203–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23895891
Mayo JR, Clifton JC, Powell TI, English JC, Evans KG, Yee J, et al. Lung nodules: CT-guided placement of microcoils to direct video-assisted thoracoscopic surgical resection. Radiology [Internet]. 2009;250:576–85. Available from: http://pubs.rsna.org/doi/https://doi.org/10.1148/radiol.2502080442
Kawanaka K, Nomori H, Mori T, Ikeda K, Ikeda O, Tomiguchi S, et al. Marking of small pulmonary nodules before thoracoscopic resection: injection of lipiodol under CT-fluoroscopic guidance. Acad Radiol [Internet]. 2009 [cited 2011 Jun 16];16:39–45. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19064210
Watanabe K, Nomori H, Ohtsuka T, Kaji M, Naruke T, Suemasu K. Usefulness and complications of computed tomography-guided lipiodol marking for fluoroscopy-assisted thoracoscopic resection of small pulmonary nodules: experience with 174 nodules. J Thorac Cardiovasc Surg [Internet]. 2006 [cited 2011 Jun 16];132:320–4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16872957
Khereba M, Ferraro P, Duranceau A, Martin J, Goudie E, Thiffault V, et al. Thoracoscopic localization of intraparenchymal pulmonary nodules using direct intracavitary thoracoscopic ultrasonography prevents conversion of VATS procedures to thoracotomy in selected patients. J Thorac Cardiovasc Surg [Internet]. 2012 [cited 2019 Apr 16];144:1160–6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22980667
Mattioli S, D’Ovidio F, Daddi N, Ferruzzi L, Pilotti V, Ruffato A, et al. Transthoracic endosonography for the intraoperative localization of lung nodules. Ann Thorac Surg. 2005;79:443–9.
Kondo R, Yoshida K, Hamanaka K, Hashizume M, Ushiyama T, Hyogotani A, et al. Intraoperative ultrasonographic localization of pulmonary ground-glass opacities. J Thorac Cardiovasc Surg [Internet]. 2009 [cited 2019 Apr 16];138:837–42. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022522309001779
Matsumoto S, Hirata T, Ogawa E, Fukuse T, Ueda H, Koyama T, et al. Ultrasonographic evaluation of small nodules in the peripheral lung during video-assisted thoracic surgery (VATS). Eur J Cardio-thoracic Surg. 2004;26:469–73.
Ambrogi MC, Dini P, Boni G, Melfi F, Lucchi M, Fanucchi O, et al. A strategy for thoracoscopic resection of small pulmonary nodules. Surg Endosc Other Interv Tech. 2005;19:1644–7.
Piolanti M, Coppola F, Papa S, Pilotti V, Mattioli S, Gavelli G. Ultrasonographic localization of occult pulmonary nodules during video-assisted thoracic surgery. Eur Radiol. 2003;13:2358–64.
Sakao Y, Nakazono T, Tomimitsu S, Takeda Y, Sakuragi T, Natsuaki M, et al. Lung adenocarcinoma can be subtyped according to tumor dimension by computed tomography mediastinal-window setting. Additional size criteria for clinical T1 adenocarcinoma. Eur J Cardiothorac Surg [Internet]. Oxford Academic; 2004 [cited 2020 May 25];26:1211–5. Available from: https://academic.oup.com/ejcts/article-lookup/doi/https://doi.org/10.1016/j.ejcts.2004.08.021
Sakao Y, Kuroda H, Mun M, Uehara H, Motoi N, Ishikawa Y, et al. Prognostic significance of tumor size of small lung adenocarcinomas evaluated with mediastinal window settings on computed tomography. Adusumilli PS, editor. PLoS One [Internet]. Public Library of Science; 2014 [cited 2020 May 25];9:e110305. Available from: https://dx.plos.org/https://doi.org/10.1371/journal.pone.0110305
Sakakura N, Inaba Y, Yatabe Y, Mizuno T, Kuroda H, Yoshimura K, et al. Estimation of the pathological invasive size of pulmonary adenocarcinoma using high-resolution computed tomography of the chest: A consideration based on lung and mediastinal window settings. Lung Cancer [Internet]. 2016;95:51–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0169500216302367
Travis WD, Asamura H, Bankier AA, Beasley MB, Detterbeck F, Flieder DB, et al. The IASLC lung cancer staging project: proposals for coding T categories for subsolid nodules and assessment of tumor size in part-solid tumors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol [Internet]. 2016;11:1204–23. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27107787
Sekimura A, Funasaki A, Iwai S, Motono N, Usuda K, Uramoto H. Thoracoscopic small pulmonary nodule detection using computed tomography-guided cutaneous marking and pleural marking. J Thorac Dis [Internet]. 2019;11:2745–53. Available from: https://jtd.amegroups.com/article/view/29944/21777
Miyoshi R, Yamashina A, Nishikawa S, Tamari S, Noguchi M, Hijiya K, et al. Skin marking with computed tomography at functional residual capacity to predict lung nodule site. Interact Cardiovasc Thorac Surg [Internet]. 2020;30:36–8. Available from: https://academic.oup.com/icvts/article/30/1/36/5575248
Acknowledgement
We thank Kelly Zammit, BVSc, from Edanz Group (https://en-author-services.edanzgroup.com/) for editing a draft of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None declared.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Yokote, F., Yamauchi, Y., Uehara, H. et al. Intrathoracic use of a small ultrasonic probe for localizing small lung tumors in thoracoscopic surgery: Empirical results and comparison with preoperative CT images. Gen Thorac Cardiovasc Surg 69, 516–524 (2021). https://doi.org/10.1007/s11748-020-01514-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-020-01514-z