Study objective: To determine the indications for
preoperative localization of a small indeterminate pulmonary
Design: In this retrospective study,
univariate and multivariate analyses were performed by the logistic
Setting: A single National
Cancer Center Hospital in Japan.
Patients: A series of
92 consecutive patients who underwent video-assisted thoracoscopic
surgery (VATS) at our institute between 1993 and 1996.
Interventions: The frequency and reasons for conversion to
thoracotomy were assessed retrospectively. All preoperative CT scans
were reviewed for eight radiologic features by two of the authors.
These data were entered into univariate and multivariate analyses to
identify the significant risk factors for a failure to detect a
Measurements and results: Fifty
patients (54%) needed conversion to a thoracotomy. The most common
reason for the conversion was failure to localize nodules (46%).
Univariate and multivariate analyses of 11 variables revealed one
significant risk factor in the failure to detect nodules:
distance to the nearest pleural surface (p < 0.05). Tumor size on
radiograph remained marginally significant (p = 0.065) in
multivariate analyses. If the distance to the pleural surface was > 5
mm in cases of nodules ≤ 10 mm in size, the probability of failure to
detect a nodule was 63%.
results suggested the indications for preoperative localization of a
peripheral pulmonary nodule. Preoperative marking for a small
indeterminate pulmonary nodule should be considered when the distance
to the nearest pleural surface is > 5 mm in cases of lung nodules of≤
10 mm in size.
LBAC = localized bronchioloalveolar carcinoma;
VATS = video-assisted thoracoscopic surgery