Prediction of lung tumor palpability using high-resolution computed tomography. (January 2016)

• Record Type: Journal Article
• Authors: Isaka, Tetsuya; Ito, Hiroyuki; Yokose, Tomoyuki; Kondo, Tetsuro; Nagata, Masashi; Nishii, Teppei; Yamada, Kouzo; Nakayama, Haruhiko; Masuda, Munetaka
• Is Part Of: Asian cardiovascular & thoracic annals. Volume 24:Number 1(2016)
• Page Start: 23
• Page End: 29
• Publication Date: 2016-01
• Subjects: Adenocarcinoma -- bronchiolo-alveolar -- Fibrosis -- Lung neoplasms -- Palpation -- Thoracic surgery -- video-assisted -- Tomography -- X-ray computed; Heart -- Diseases -- Asia -- Periodicals; Heart -- Diseases -- Pacific Area -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Surgery -- Asia -- Periodicals; Heart -- Surgery -- Pacific Area -- Periodicals; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Asia -- Periodicals; Chest -- Surgery -- Pacific Area -- Periodicals; Chest -- Surgery -- Periodicals; 617.412
• DOI: 10.1177/0218492315615480
• Languages: English
• ISSNs: 0218-4923

Abstract

Background: Palpation is the most important means of locating lung tumors and resecting them with sufficient margins. This study aimed to predict the palpability of pulmonary lesions using high-resolution computed tomography. Methods: Eighty-six pulmonary lesions were palpated in fresh resected lung specimens from July 2013 to March 2014. The following parameters were compared between 10 impalpable and 76 palpable lesions: maximum tumor size in pulmonary and bone window level settings, consolidation tumor size in pulmonary window level setting, and pleural-tumor distance. In 54 adenocarcinomas, the lepidic component and fibrosis foci rates were compared between the two groups. Results: Tumor size in bone window level setting and the consolidation tumor size were significantly smaller in the impalpable group (both p < 0.001), and an operational cutoff of 5 mm was identified by receiver-operating characteristic analysis (sensitivity/specificity was 90.0%/94.7% and 90.0%/86.9%, respectively). Pulmonary lesions were impalpable with 87.5% probability when the tumor size in bone window level setting was ≤5 mm and the pleural-tumor distance was ≥ 5 mm, and with 85.7% probability when the consolidation tumor size was ≤5 mm and the pleural-tumor distance was ≥ 5 mm. Lepidic component and fibrosis foci rates of impalpable/palpable lesions were 96.0%/52.8% and 4.0%/24.7%, respectively (both p < 0.001). Conclusions: Tumor size in bone window level setting or a consolidation tumor size ≤5 mm and pleural-tumor distance ≥ 5 mm are simple criteria that are potentially useful indicators for preoperative marking to locate small-sized lepidic-predominant adenocarcinomas with few fibrotic foci.