Is palpation of the nonresected pulmonary lobe(s) required for patients with non–small cell lung cancer? A prospective study

Objective

Video-assisted lobectomy is an increasingly used technique to treat patients with non–small cell lung cancer but it does not usually afford lung palpation.

Methods

A prospective study was conducted on patients with tumors amenable to video-assisted lobectomy (noncentral lesion and <5 cm) who underwent open lobectomy via thoracotomy. All patients underwent 64-slice helical computed tomographic scan with intravenous contrast at 5-mm intervals and had integrated 2-deoxy-2-18F-fluoro-d-glucose positron emission tomography computed tomography 30 days or less before thoracotomy. Unsuspected malignant pulmonary nodules that were palpated and removed (from a different lobe than the one resected) and that were not imaged preoperatively were defined as cancer that would have been missed by video-assisted lobectomy.

Results

From January 2006 to February 2007, 166 patients had non–small cell lesions that were resected via thoracotomy, despite being amenable to video-assisted surgery, by one surgeon. Thirty-seven (22%) patients had pulmonary nodules that probably would have been missed by video-assisted lobectomy; 14 (8.4%) of these nodules were malignant. These were unsuspected M1 pulmonary lesions in 9 patients and unsuspected different types of primary non–small cell lung cancers in 5 patients. All missed lesions were less than 6 mm and in different lobes from the one resected. Nine (64%) of these 14 patients' primary known lesions were pathologic T1 lesions. Nine patients received adjuvant chemotherapy because of these unsuspected M1 nodules.

Conclusions

Open lobectomy that affords palpation of the rest of the lung may discover nonimaged malignant pulmonary nodules in different lobes in 8% to 9% of patients with non–small cell lung cancer despite preoperative fine-cut chest computed tomographic scan with contrast and integrated integrated 2-deoxy-2-18F-fluoro-d-glucose positron emission tomography computed tomographic scanning. The clinical impact of these findings is unknown.

CTSNet classification: 10, 11

Abbreviations and Acronyms: CT, computed tomography, FDG-PET/CT, 2-deoxy-2-18F-fluoro-d-glucose positron emission tomography computed tomography, maxSUV, maximum standardized uptake value, NSCLC, non–small cell lung cancer, PET, Positron emission tomography, UAB, University of Alabama at Birmingham, VATS, video assisted thoracoscopic surgery