The Value of Thoracoscopic Ultrasound for the Localization of Ground-glass Opacities with Incomplete Lung Collapse in Video-assisted Thoracoscopic Surgery

Overview

Journal Quant Imaging Med Surg

Specialty Radiology

Date 2024 Dec 19

PMID 39698688

Authors

Cong-Xuan Zhao

Nan Sun

Lin-Wei Hong

Fang-Xu Li

Fu-Zhi Pan

Ning-Ning Gao

Dong-Man Ye

Tao Yu

Xin-Wu Cui

Affiliations

Soon will be listed here.

Abstract

Background: Video-assisted thoracoscopic surgery (VATS) has been widely used for the resection of lung lesions. However, it is difficult to palpate or see small lesions, especially ground-glass opacities (GGOs) during VATS. Thoracoscopic ultrasound has definite value in locating pulmonary parenchymal nodules. However, due to the air in the lung parenchyma, its wide application is limited. This study investigated the value of thoracoscopic ultrasound for the localization of GGOs with incomplete lung collapse in VATS.

Methods: A retrospective analysis was conducted on patients diagnosed with ground-glass nodules (GGNs) on computed tomography (CT) at Liaoning Province Tumor Hospital from November 2018 to August 2019, who underwent thoracoscopic ultrasound localization and VATS. Screening was conducted for patients who did not achieve complete collapse of the lungs after natural collapse during surgery, the success rate was calculated, and preoperative CT features and thoracoscopic ultrasound features of GGNs were summarized and analyzed.

Results: The success rate of GGOs' localization by thoracoscopic ultrasound in incomplete collapse lung was 56.67%. Of all preoperative CT features, only the distance between the nodule and the pleura was statistically different (P=0.001). The closer the GGO was to the pleura, the easier it was to be detected.

Conclusions: Thoracoscopic ultrasound could effectively locate GGO in the condition of incomplete lung collapse and not affect the surgical field, especially when the GGO is close to the pleura, which provides an alternative method for GGO localization in patients who cannot achieve complete lung collapse during VATS.

References

Serpa Neto A, Hemmes S, S V Barbas C, Beiderlinden M, Biehl M, Binnekade J . Protective versus Conventional Ventilation for Surgery: A Systematic Review and Individual Patient Data Meta-analysis. Anesthesiology. 2015; 123(1):66-78. DOI: 10.1097/ALN.0000000000000706. View

Campos J, Feider A . Hypoxia During One-Lung Ventilation-A Review and Update. J Cardiothorac Vasc Anesth. 2018; 32(5):2330-2338. DOI: 10.1053/j.jvca.2017.12.026. View

Yamamoto M, Takeo M, Meguro F, Ishikawa T . Sonographic evaluation for peripheral pulmonary nodules during video-assisted thoracoscopic surgery. Surg Endosc. 2003; 17(5):825-7. DOI: 10.1007/s00464-002-8900-0. View

Yankelevitz D, Yip R, Smith J, Liang M, Liu Y, Xu D . CT Screening for Lung Cancer: Nonsolid Nodules in Baseline and Annual Repeat Rounds. Radiology. 2015; 277(2):555-64. PMC: 4627436. DOI: 10.1148/radiol.2015142554. View

Liang C, Lv Y, Shi Y, Cang J, Miao C . The fraction of nitrous oxide in oxygen for facilitating lung collapse during one-lung ventilation with double lumen tube. BMC Anesthesiol. 2020; 20(1):180. PMC: 7374913. DOI: 10.1186/s12871-020-01102-x. View

Hansell D, Bankier A, MacMahon H, McLoud T, Muller N, Remy J . Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008; 246(3):697-722. DOI: 10.1148/radiol.2462070712. View

Kaufmann K, Heinrich S . Minimizing postoperative pulmonary complications in thoracic surgery patients. Curr Opin Anaesthesiol. 2020; 34(1):13-19. DOI: 10.1097/ACO.0000000000000945. View

Lagier D, Zeng C, Fernandez-Bustamante A, Melo M . Perioperative Pulmonary Atelectasis: Part II. Clinical Implications. Anesthesiology. 2021; 136(1):206-236. PMC: 9885487. DOI: 10.1097/ALN.0000000000004009. View

Kondo R, Yoshida K, Hamanaka K, Hashizume M, Ushiyama T, Hyogotani A . Intraoperative ultrasonographic localization of pulmonary ground-glass opacities. J Thorac Cardiovasc Surg. 2009; 138(4):837-42. DOI: 10.1016/j.jtcvs.2009.02.002. View

10.

Santini M, Fiorelli A, Messina G, Laperuta P, Mazzella A, Accardo M . Use of the LigaSure device and the Stapler for closure of the small bowel: a comparative ex vivo study. Surg Today. 2012; 43(7):787-93. DOI: 10.1007/s00595-012-0336-0. View

11.

Migliore M, Fornito M, Palazzolo M, Criscione A, Gangemi M, Borrata F . Ground glass opacities management in the lung cancer screening era. Ann Transl Med. 2018; 6(5):90. PMC: 5890046. DOI: 10.21037/atm.2017.07.28. View

12.

Fiorelli A, Messina G, Frongillo E, Accardo M, Montella M, Panarese I . The use of ultrasound in detecting and defining ground-glass opacities: results of an ex vivo evaluation. Interact Cardiovasc Thorac Surg. 2017; 26(4):551-558. DOI: 10.1093/icvts/ivx373. View

13.

Huang Y, Chen K, Chen J . Ultrasound for intraoperative localization of lung nodules during thoracoscopic surgery. Ann Transl Med. 2019; 7(2):37. PMC: 6381266. DOI: 10.21037/atm.2019.01.41. View

14.

Choi H, Mazzone P . Lung Cancer Screening. Med Clin North Am. 2022; 106(6):1041-1053. DOI: 10.1016/j.mcna.2022.07.007. View

15.

Li Q, Fan L, Cao E, Li Q, Gu Y, Liu S . Quantitative CT analysis of pulmonary pure ground-glass nodule predicts histological invasiveness. Eur J Radiol. 2017; 89:67-71. DOI: 10.1016/j.ejrad.2017.01.024. View

16.

El-Tahan M . A comparison of the disconnection technique with continuous bronchial suction for lung deflation when using the Arndt endobronchial blocker during video-assisted thoracoscopy: A randomised trial. Eur J Anaesthesiol. 2015; 32(6):411-7. DOI: 10.1097/EJA.0000000000000194. View

17.

MacMahon H, Naidich D, Goo J, Lee K, Leung A, Mayo J . Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology. 2017; 284(1):228-243. DOI: 10.1148/radiol.2017161659. View

18.

Messina G, Bove M, Natale G, Noro A, Martone M, Opromolla G . Ultrasound location of ground-glass opacity during thoracoscopic surgery. Interact Cardiovasc Thorac Surg. 2022; 35(6). PMC: 9749129. DOI: 10.1093/icvts/ivac234. View

19.

Zhou D, Zhang Y, Chen W, Jiang J, Chen Y, Zhou X . Enhanced ultrasound-guided versus non-enhanced ultrasound-guided percutaneous needle biopsy in tissue cellularity of lung malignancies: a propensity score matched study. Quant Imaging Med Surg. 2022; 12(11):5056-5067. PMC: 9622440. DOI: 10.21037/qims-22-119. View

20.

Reber A, Engberg G, Sporre B, Kviele L, Rothen H, Wegenius G . Volumetric analysis of aeration in the lungs during general anaesthesia. Br J Anaesth. 1996; 76(6):760-6. DOI: 10.1093/bja/76.6.760. View