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R. Sumitomo



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    MINI 32 - Topics in Localized Lung Cancer (ID 166)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Treatment of Localized Disease - NSCLC
    • Presentations: 1
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      MINI32.03 - Accuracy of Respiratory Dynamic Computed Tomography for the Detection of Pleural Adhesions (ID 805)

      18:30 - 20:00  |  Author(s): R. Sumitomo

      • Abstract
      • Presentation

      Background:
      Video-assisted thoracic surgery (VATS) plays an important role in thoracic surgery especially for early stage lung cancer because it is less invasive. However, the existence of severe pleural adhesions may make VATS difficult and complicated. So, preoperative detection of pleural adhesions can be very useful for the assessment of surgical approach. The aim of this study was to assess the accuracy of inspiration and expiration computed tomography (respiratory dynamic CT: RD-CT) in evaluation of pleural adhesions prior to thoracic surgery. Video-assisted thoracic surgery (VATS) plays an important role in thoracic surgery especially for early stage lung cancer because it is less invasive. However, the existence of severe pleural adhesions may make VATS difficult and complicated. So, preoperative detection of pleural adhesions can be very useful for the assessment of surgical approach. The aim of this study was to assess the accuracy of inspiration and expiration computed tomography (respiratory dynamic CT: RD-CT) in evaluation of pleural adhesions prior to thoracic surgery.

      Methods:
      From January to December 2014, RD-CT was performed on 107 patients undergoing thoracotomies (both VATS and open surgery, except for pneumothorax). We assessed synchronous motion during respiration on RD-CT using a three-dimensional CT image software, as Sliding Score. Regarding intraoperative findings, we categorized the severity of pleural adhesions into 4 groups as Adhesion Grade. Then, comparing Sliding Score and Adhesion Grade, we assessed the utility of preoperative evaluation. In addition, to confirm these patients could expire enough in expiration phase, we assumed lung volume in expiration phase/ inspiration phase as CT- Respiratory Ratio in each case.

      Results:
      Operations were performed mainly for lung cancer (78 cases; 72.9%), others are metastatic lung tumor, mediastinal tumor, lung abcess and so on. A negative correlation between Sliding Score and Adhesion Grade was revealed. Sliding Score in adhesion positive patients was significantly higher than that in adhesion negative patients (P < 0.0001). The sensitivity of RD-CT was 63.6%, specificity was 74.1%, and accuracy was 72%. Among 62 patients with a CT-Respiration Ratio of less than 0.65, the sensitivity of RD-CT was 77.8%, specificity was 86.8%, and accuracy was 85.5%. Regarding severe adhesions, RD-CT demonstrated a sensitivity of 100% in all 107 patients. No significant correlation was revealed between CT- Respiratory Ratio and respiratory function or Adhesion Grade.

      Conclusion:
      RD-CT may be useful for detecting the presence of pleural adhesions, especially to rule out the severest adhesions. It can be adopted as one of the criteria for deciding the surgical approach, VATS or open surgery. And it may enable an operation to be performed more safely and systematically.

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