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The preoperative assessment of thoracic wall adhesions using four-dimensional computed tomography

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Abstract

Objective

Pleural adhesions are challenging during lung cancer surgery and may be associated with a long surgery time and excessive blood loss due to pleural adhesiolysis. We used preoperative four-dimensional computed tomography to quantitatively assess parietal pleural adhesions and determine its diagnostic accuracy.

Methods

A total of 216 patients with lung cancer underwent four-dimensional computed tomography during the study period. Pleural adhesions were subsequently confirmed by surgery in 85 of these patients, whereas 126 patients had no adhesions. The movements of the tumor or target vessels (α) was tracked. Receiver-operating characteristic curve analysis was used to identify the relationship between adhesions and (α).

Results

The movement of (α) was smaller in patients with adhesions than in those without adhesions. The greater the adhesion, the shorter the movement distance (p < 0.001). Receiver-operating characteristic curve analysis demonstrated an area under the curve for the moving (α) point at 0.71 (95% confidence interval: 0.62–0.80) in the upper lung field and at 0.75 (95% confidence interval: 0.64–0.85) in the lower field. To identify adhesions, a cut off of 11.3 mm (sensitivity = 43.6%, specificity = 93.2%) in the upper lung field and a cut off of 41.2 mm (sensitivity = 71.4%, specificity = 66.0%) in the lower lung field were established.

Conclusions

Four-dimensional computed tomography is a novel and helpful modality for predicting the presence of parietal pleural adhesions. To obtain robust evidence, further accumulation of cases and re-examination of the analysis methods are needed.

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Funding

This study did not receive any external funding or grant support.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Surgery II, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan

    Jun Suzuki, Satoshi Shiono, Katsuyuki Suzuki, Hikaru Watanabe, Satoshi Takamori, Takayuki Sasage, Kaito Sato, Yusuke Matsui & Testsuro Uchida

  2. Faculty of Medicine, Department of Radiology, Division of Diagnostic Radiology, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan

    Fumika Watarai

Authors
  1. Jun Suzuki
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  2. Satoshi Shiono
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  3. Katsuyuki Suzuki
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  4. Hikaru Watanabe
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  5. Satoshi Takamori
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  6. Takayuki Sasage
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  8. Yusuke Matsui
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  9. Testsuro Uchida
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  10. Fumika Watarai
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Correspondence to Jun Suzuki.

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Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 32001 KB) Video 1. 4DCT image showing no adhesions or severe adhesions

Supplementary file2 (MP4 92449 KB) Video 2. Intraoperative findings

Supplementary file3 (PNG 224 KB) Online Resource 1. Patient selection

Supplementary file4 (PNG 423 KB) Online Resource 2. Description of the strength and extent of adhesions

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Suzuki, J., Shiono, S., Suzuki, K. et al. The preoperative assessment of thoracic wall adhesions using four-dimensional computed tomography. Gen Thorac Cardiovasc Surg 71, 464–471 (2023). https://doi.org/10.1007/s11748-023-01912-z

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  • DOI: https://doi.org/10.1007/s11748-023-01912-z

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