Missed pulmonary metastasis

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Diagnostic Imaging

Background:

• Preoperative computed tomography (CT) is standard for detecting pulmonary nodules.
• However, CT may miss non-imaged pulmonary nodules, potentially affecting surgical outcomes.
• Bimanual lung palpation during thoracotomy offers a tactile method for nodule detection.

Purpose of the Study:

• To evaluate the detection rate of pulmonary nodules via intraoperative palpation.
• To compare palpation findings with preoperative CT imaging in patients undergoing thoracotomy for metastasectomy.
• To determine the incidence of non-imaged pulmonary nodules and their characteristics.

Main Methods:

• Retrospective analysis of 215 pulmonary metastasectomies performed between 2001-2011.
• Comparison of nodules identified on preoperative CT with those found during intraoperative palpation and pathology.
• Classification of resected nodules as benign or malignant.

Main Results:

• Thoracotomy identified non-imaged pulmonary nodules in 36% of cases.
• The incidence was higher for mesenchymal tumors (41%) compared to epithelial tumors (28%).
• Malignant, non-imaged pulmonary metastases were found in 36% of patients.

Conclusions:

• Open metastasectomy with bimanual lung palpation significantly improves the detection of pulmonary nodules.
• This approach is vital for identifying malignant metastases missed by preoperative imaging.
• Bimanual palpation enhances surgical staging and treatment planning for lung metastases.