Intraoperative ultrasonographic localization of pulmonary ground-glass opacities

Kondo, Ryoichi; Yoshida, Kazuo; Hamanaka, Kazutoshi; Hashizume, Masahiro; Ushiyama, Toshiki; Hyogotani, Akira; Kurai, Makoto; Kawakami, Satoshi; Fukushima, Mana; Amano, Jun

doi:10.1016/j.jtcvs.2009.02.002

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 4 , Pages 837-842, October 2009

Intraoperative ultrasonographic localization of pulmonary ground-glass opacities

Ryoichi Kondo, MD, PhD
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
- Address for reprints: Ryoichi Kondo, MD, PhD, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
Kazuo Yoshida, MD, PhD
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
Kazutoshi Hamanaka, MD
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
Masahiro Hashizume, MD
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
Toshiki Ushiyama, MD
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
Akira Hyogotani, MD
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
Makoto Kurai, MD
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
Satoshi Kawakami, MD
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
Mana Fukushima, MD
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
Jun Amano, MD, PhD
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan

Received 28 May 2008; received in revised form 20 December 2008; accepted 2 February 2009. published online 27 March 2009.

Objectives

Ground-glass opacities are typically difficult to inspect and to palpate during video-assisted thoracic surgery. We therefore examined whether ultrasonographic assessments could localize ground-glass opacities and help to achieve adequate resection margins.

Methods

An intraoperative ultrasonographic procedure was prospectively performed on 44 patients harboring ground-glass opacities of less than 20 mm in diameter to localize these lesions and to achieve adequate margins. We also examined whether there were any complications resulting from the intraoperative ultrasonogram, such as lung injury, heart injury, or arrhythmia. We excluded patients with both asthma and chronic obstructive pulmonary disease from this study inasmuch as the intraoperative ultrasonographic procedure is more difficult to interpret when residual air is present in the lung.

Results

A total of 53 ground-glass opacities were successfully identified by intraoperative ultrasonography without any complications. Of the 20 mixed ground-glass opacities that we examined, 15 were found on palpation. However, only 4 (12.1%) of the 33 pure ground-glass opacities could be palpated. In all instances in which complete collapse of the lung was achieved (30/53 of these cases), high-quality echo images were obtained. Additionally, a strong correlation was found between the resection margins measured by ultrasonogram and the margins determined by histologic examination in the resected lung specimens (r² = 0.954, P < .001).

Conclusions

Intraoperative ultrasonography can both safely and effectively localize pulmonary ground-glass opacities in a completely deflated lung. This procedure is also useful for the evaluation of surgical margins in a resected lung. Hence, ultrasonography may assist surgeons to perform minimally invasive lung resections with clear surgical margins during the treatment of solitary lung ground-glass opacity.

Abbreviations and Acronyms: CT, computed tomography, GGO, ground-glass opacity, IU, intraoperative ultrasonography, VATS, video-assisted thoracic surgery

CTSNet classification: 10, 11, 28