Intrathoracic use of a small ultrasonic probe for localizing small lung tumors in thoracoscopic surgery: Empirical resul
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ORIGINAL ARTICLE
Intrathoracic use of a small ultrasonic probe for localizing small lung tumors in thoracoscopic surgery: Empirical results and comparison with preoperative CT images Fumi Yokote1 · Yoshikane Yamauchi1 · Hirofumi Uehara1 · Suguru Shirai1 · Atsushi Yasuda2 · Yuichi Saito1 · Yukinori Sakao1 · Masafumi Kawamura1 Received: 21 July 2020 / Accepted: 4 October 2020 © The Japanese Association for Thoracic Surgery 2020
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). Keywords Lung tumor · Thoracoscopic ultrasonography · Intrathoracic positive pressure 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) * Yoshikane Yamauchi [email protected]‑u.ac.jp 1
Department of Surgery, Teikyo University School of Medicine, 2‑11‑1 Kaga, Itabashi‑ku, Tokyo 173‑8605, Japan
Department of Anesthesiology, Teikyo University School of Medicine, Tokyo, Japan
2
MD Tumor dimension in the mediastinal window (MD) GD Good depiction UD Unclear depiction NV Non-visible
Introduction Thoracic surgeons are now required to manage patients with small lung tumors owing to the widespread use of computed tomography (CT). Such tumors are frequently resected
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