Die präoperative Dünnschicht-Computertomografie im Management der Lungenmetastasenchirurgie

Abstract

Inspection and palpation of the ventilated and exhausted lung reflect the guideline-compliant surgery of pulmonary metastases. Because a huge number of pulmonary nodules are missed on preoperative CT, metastases must be diagnosed by the surgeon's examination of the lung under exclusion of the video-assisted approach. The purpose of our study was to assess whether a special multislice (MS) spiral CT may close this diagnostic gap and change the management of pulmonary surgery. We performed a prospective study to address this question. Operative and histological results of 60 patients with pulmonary nodules (7/2002 and 12/2004) were compared with the preoperative predictions of MS-CT. In 81 operations, 166 pulmonary metastases were confirmed histologically. The MS-CT predicted 229 suspicious metastases; 38% could not be confirmed histologically. However, in 14% of surgically confirmed metastases the radiological correlate was absent. 44% of these metastases were <or=2 mm, 30%<or=4 mm, and 26%>4 mm; and were from the following primary entities: 48% hypernephroma, 30% sarcoma, 17% colorectal carcinoma and 4% breast cancer. The radiological prediction of 1 to 3 vs. 5 to 11 metastases implied 30% vs. 70% additional filiae, whereas radiologically non-described metastases were found in 12% of all operations. In contrast, the group with radiopaque material showed only 5% of metastases without a radiological correlate or 8% of non-described metastases. The overall sensitivity of MS-CT was 86%, whereas the group with radiopaque material had a sensitivity of 95%. The preoperative MS-CT does not resolve the problem of overlooked metastases and has no influence on the management of pulmonary surgery.