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Ann Thorac Surg 2004;78:1910-1918
© 2004 The Society of Thoracic Surgeons

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Original article: general thoracic

Accuracy of Helical CT in the Detection of Pulmonary Metastases: Is Intraoperative Palpation Still Necessary?

^a Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
^b Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
^c Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

Accepted for publication May 17, 2004.

^* Address reprint requests to Dr Detterbeck, Division of Cardiothoracic Surgery, Medical School Wing C, Room 354, CB #7065, University of North Carolina, Chapel Hill, NC 27599-7065, USA
fdetter{at}med.unc.edu

Presented at the Fortieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.

BACKGROUND: Pulmonary metastasectomy is well accepted in patients with isolated metastases from an extrathoracic malignancy. The standard approach involves careful intraoperative palpation of the lungs because more metastases are frequently found than were seen by preoperative conventional computed tomography (CT). Helical CT detects more nodules than conventional CT, raising the question of whether palpation of the lungs is still necessary if helical CT is used.

METHODS: Retrospective review was done of medical records of patients undergoing metastasectomy with curative intent at the University of North Carolina (UNC) from 1999 to 2003. During this time at UNC, helical CT was routinely performed using a standardized technique, and all metastasectomy patients underwent manual lung palpation. The primary outcome measure of this study was whether malignant nodules (palpated, resected, and proven histologically) were reliably detected preoperatively by helical CT.

RESULTS: Thirty-four patients were identified who underwent 41 cases of pulmonary metastasectomy with lung palpation. Our analysis revealed that in 22% (9/41), more malignant nodules were found intraoperatively than were detected by helical CT. Of 88 malignant intraparenchymal nodules, 69 were detected by helical CT (sensitivity 78%). Subset analyses of tumor histology, disease-free interval, the presence of a single lesion versus multiple lesions, the interval between the CT and metastasectomy, and the size of the largest lesion were unable to identify a cohort in which lung palpation was no longer needed after preoperative helical CT.

CONCLUSIONS: Despite the advent of helical CT, palpation of the lung is necessary if the goal is to resect all detectable disease.

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