A Prospective Study to Determine the Incidence of Non-Imaged Malignant Pulmonary Nodules in Patients Who Undergo Metastasectomy by Thoracotomy With Lung Palpation

• Published in: The Annals of thoracic surgery Vol. 91; no. 6; pp. 1696 - 1701
• Main Authors: Cerfolio, Robert J., MD, Bryant, Ayesha S., MD, McCarty, Todd P., MD, Minnich, Douglas J., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-06-2011; Elsevier
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Cohort Studies; Female; Humans; Incidence; Lung Neoplasms - secondary; Lung Neoplasms - surgery; Male; Medical sciences; Middle Aged; Palpation; Pneumology; Prospective Studies; Solitary Pulmonary Nodule - epidemiology; Surgery; Thoracic Surgery, Video-Assisted; Thoracotomy - methods; Tumors of the respiratory system and mediastinum; 11; Human; Lung disease; Respiratory disease; Lung; Patient; Malignant tumor; Thoracotomy; Incidence; Prospective; Treatment; Surgery; Lung nodule; Anesthesia; Circulatory system; Cardiology; Cancer; WHO
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2011.02.075

Background To prospectively assess the incidence of non-imaged malignant nodules in patients who undergo thoracotomy for metastasectomy with bimanual lung palpation. Methods This is a prospective cohort study of patients who underwent open metastasectomy by thoracotomy. All patients had metastatic lung lesions, underwent 64-slice helical computed tomographic (CT) scan with intravenous contrast using 5-mm collimated cuts, and most had integrated PET (positron emission tomography)-CT. Unsuspected malignant pulmonary nodules that were palpated and removed, and that were not imaged preoperatively, were recorded. Results From January 2006 to March 2010, 152 patients underwent metastasectomy by rib-sparing, nerve-sparing thoracotomy by 1 surgeon. Fifty-one (34%) patients had 57 pulmonary nodules that were not imaged preoperatively and 32 of the 57 (56%) nodules were malignant. Thirty patients had non-imaged malignant nodules that were palpated and removed. There were 15 malignant nodules that were in different lobes than the imaged nodules. The 3 most commonly missed malignant nodules occurred in patients with colorectal cancer, renal cell, and sarcoma. Conclusions Metastasectomy by thoracotomy, which affords bimanual palpation of the entire lung, discovers ipsilateral non-imaged malignant pulmonary metastases in 1 of 5 patients who had at least 1 imaged metastatic pulmonary lesion. This is true despite preoperative, fine cut chest CT scan with contrast, and integrated 18F-fluorodeoxyglucose-PET-CT scanning. The clinical significance of these non-imaged, resected malignant nodules is unknown, nor is the added morbidity of resecting benign nodules.