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Original Articles: General Thoracic

Endothoracic Sonography Improves the Estimation of Operability in Locally Advanced Lung Cancer

Department of Thoracic and Vascular Surgery, SRH Wald-Klinikum Gera, Teaching Hospital of Friedrich-Schiller-University of Jena, Gera, Germany

Accepted for publication March 26, 2010.

^_* Address correspondence to Prof Dr Lesser, Department of Thoracic and Vascular Surgery, SRH Wald-Klinikum Gera, Straße des Friedens 122, D-07548 Gera, Germany (Email: thomas.lesser{at}wkg.srh.de).

Background: Patients with T4 non-small cell lung cancers with limited involvement of mediastinal structures can undergo resection, with acceptable long-term survival. Computed tomography has not proven to be reliable in determining the operability of locally advanced lung carcinoma. This study evaluated the ability of video-assisted thoracoscopy alone and with endothoracic sonography to determine operability.

Methods: Computed tomography showed a close contact of the tumor with mediastinal structures (T4) in 155 patients. Staging was expanded with video-assisted thoracoscopy, followed by thoracoscopic ultrasound. Lateral thoracotomy with hilar and mediastinal dissection was considered the gold standard in determining operability.

Results: Thoracoscopic ultrasound, compared with thoracoscopy alone and computed tomography, had the highest sensitivity (94.1% vs 75.2% vs 43.6%, p < 0.001) and specificity (98.1% vs 57.4% vs 37.0%, p < 0.001) for determining operability. Computed tomography, thoracoscopy, and thoracoscopic ultrasound were falsely negative in 57 (36.8%), 25 (16.1%), and 6 (3.9%) patients and falsely positive in 34 (21.9%), 23 (14.8%), and 1 (0.6%). False-negative results for operability by thoracoscopic ultrasound were found only in tumors involving the left atrium (3.9%).

Conclusions: Estimation of operability in locally advanced lung cancer can be improved with video-assisted thoracoscopy and ultrasound. More than one-third of patients classified as inoperable by computed tomography were able to undergo complete resection.

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Invited Commentary

James S. Allan
Ann. Thorac. Surg. 2010 90: 222. [Extract] [Full Text] [PDF]

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				J. S. Allan Invited Commentary Ann. Thorac. Surg., July 1, 2010; 90(1): 222 - 222. [Full Text] [PDF]