Die präoperative Dünnschicht-Computertomografie im Management der Lungenmetastasenchirurgie

INTRODUCTION: Inspection and palpation of the ventilated and exhausted lung reflect the guideline-compliant surgery of pulmonary metastases. Because a huge number of pulmonary nodules are missed on preoperative CT, metastases must be diagnosed by the surgeon's examination of the lung under exclusion of the video-assisted approach. The purpose of our study was to assess whether a special multislice (MS) spiral CT may close this diagnostic gap and change the management of pulmonary surgery. PATIENTS AND METHODS: We performed a prospective study to address this question. Operative and histological results of 60 patients with pulmonary nodules (7 / 2002 and 12 / 2004) were compared with the preoperative predictions of MS-CT. RESULTS: In 81 operations, 166 pulmonary metastases were confirmed histologically. The MS-CT predicted 229 suspicious metastases; 38 % could not be confirmed histologically. However, in 14 % of surgically confirmed metastases the radiological correlate was absent. 44 % of these metastases were ≤ 2 mm, 30 % ≤ 4 mm, and 26 % > 4 mm; and were from the following primary entities: 48 % hypernephroma, 30 % sarcoma, 17 % colorectal carcinoma and 4 % breast cancer. The radiological prediction of 1 to 3 vs. 5 to 11 metastases implied 30 % vs. 70 % additional filiae, whereas radiologically non-described metastases were found in 12 % of all operations. In contrast, the group with radiopaque material showed only 5 % of metastases without a radiological correlate or 8 % of non-described metastases. The overall sensitivity of MS-CT was 86 %, whereas the group with radiopaque material had a sensitivity of 95 %. CONCLUSION: The preoperative MS-CT does not resolve the problem of overlooked metastases and has no influence on the management of pulmonary surgery.