Intraoperative Contrast-Enhanced Ultrasound Versus Traditional Intraoperative Ultrasound for Detecting Lung Nodules...

Intraoperative ultrasound (Io-US) is used during thoracoscopy to detect lung lesions, but it remains underused during robotic-assisted thoracic surgery (RATS), probably due to the difficulty interpreting US findings. We evaluated whether the use of contrast-enhanced ultrasound (CEUS) could improve the diagnostic accuracy of traditional Io-CEUS for detecting lung nodules during RATS.

It was a retrospective single-centre study including all consecutive patients undergoing RATS for management of small, deeply located lung nodules. In all cases, Io-CEUS was used when Io-US failed to detect lung lesion. The diagnostic accuracy of 2 methods to detect lesions and the inter-group differences regarding operative and perioperative outcomes were statistically evaluated.

Our study population included 33 patients. Io-US correctly detected 15 out of 33 lesions (45%) but missed 18 lesions with isoechoic patterns that were corrected identified by Io-CEUS with a significant improvement of diagnostic accuracy (difference 55%; 95% confidence interval: 37.56- 71.53; P < .0001). The Io-US group (n = 15) compared to the Io-CEUS group (n = 18) showed no significant differences regarding nodule characteristics such as size (8 mm [7-9] vs 7.8 mm [6-9], P = .78); distance from pleura (32 mm [20-44] vs 21 mm [20-42]; P = .69); lobe location (lower lobe: 66% vs 61%, P = .74); and histological diagnosis (primary lung cancer: 100% vs 88%, P = .18).

Io-CEUS is an additional tool for thoracic surgeons to detect lung lesions and could be useful, especially in cases of isoechoic lesions that were poorly defined by traditional Io-US.