Preoperative assessment of localized pleural adhesion: Utility of software-assisted analysis on dynamic-ventilation computed tomography

Nagatani, Yukihiro; Hashimoto, Masayuki; Oshio, Yasuhiko; Sato, Shigeo; Hanaoka, Jun; Fukunaga, Kentaro; Ryo, Uemura; Yoshigoe, Makoto; Nitta, Norihisa; Usio, Noritoshi; Tsukagoshi, Shinsuke; Kimoto, Tsunenobu; Yamashiro, Tsuneo; Moriya, Hideshige; Murata, Kiyoshi; Watanabe, Yoshiyuki

doi:10.1016/j.ejrad.2020.109347

Cited by 8 publications

(14 citation statements)

References 30 publications

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“…In addition to careful in‐operative management, more aggressive preoperative evaluation and screening of patients are needed to deal with intraoperative adhesions. Nagatani et al 18 used dynamic ventilation CT for preoperative evaluation of localized pleural adhesions with a sensitivity of 82.5%. Rosen et al used the National Cancer Database to investigate surgically treated patients who had NSCLC 19 ; they found that a high CCI was associated with high rates of postoperative adverse events and longer postoperative hospital stays.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and safety of secondary video‐assisted thoracoscopic surgery for ipsilateral lung cancer after prior pulmonary resection

et al. 2022

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Background Video‐assisted thoracoscopic surgery (VATS) is the preferred treatment for resectable non‐small cell lung cancer. The increased survival of patients after a first operation has caused increases in the incidence of locoregional recurrence or second primary lung cancer and a concomitant increase in the number of patients who require secondary surgery. Ipsilateral secondary operation is also commonly practiced, albeit with enhanced difficulty. Therefore, it is necessary to evaluate the feasibility and safety of VATS for ipsilateral lung cancer after pulmonary resection. Methods Patients who underwent ipsilateral secondary VATS in the West China Hospital, Sichuan University from 2012 to 2021 were assessed retrospectively. All included patients had a pulmonary resection. Clinical characteristics, perioperative outcomes, and survival data were collected, with an emphasis on conversion to thoracotomy, postoperative complications, 30‐day mortality, and survival. Logistic regression analysis was used to identify predictors of postoperative complications. Results Seventy patients were enrolled, of which 10 (14.3%) had converted thoracotomy, 17 (24.3%) had postoperative complications, and two (2.9%) had grade III complications. No patient died within 30 days after surgery. High Charlson comorbidity index (CCI) and severe pleural adhesion were independent predictors for complications. The median follow‐up was 50 months (range: 3–120), and the 5‐year overall survival was 78.2%. Conclusion Secondary VATS for ipsilateral lung cancer for patients who had pulmonary resection was feasible and safe. Strict preoperative evaluation and careful management of pleural adhesion are crucial for the success of the surgery.

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Section: Discussionmentioning

confidence: 99%

Feasibility and safety of secondary video‐assisted thoracoscopic surgery for ipsilateral lung cancer after prior pulmonary resection

et al. 2022

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“…Moreover, it will be more helpful in detecting local pleural adhesions by using softwareassisted analysis on dynamic-ventilation computed tomography compared with chest static CT scans. 21 However, in the present study, we focused on a merely localized pleural adhesion (Figure 1). Local adhesion of diaphragmatic pleura was found in 0.68% of individuals who received a physical examination, showing a triangularshaped pulmonic pull sign between the base of the lung and the diaphragm.…”

Section: Discussionmentioning

confidence: 99%

The Intrapleural Bridge Connection is One of the Reasons for Unknown Localized Pleural Adhesion

Gu¹,

Deng²,

Li³

et al. 2021

IJGM

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Background Simple signs of local pleural adhesion are often found in people during a physical examination. In the present study, we aimed to clarify whether the merely localized pleural adhesion was just caused by previous pleural inflammation or physiological variation. Materials and Methods Chest X-ray image materials were collected to analyze the incidence of simple pleural adhesions. Moreover, the causes of these simple pleural adhesions were further analyzed using thoracoscopy under direct vision and biopsy data. Results In all 2218 chest X-ray images, 68 cases were found to have pleural lesions (3.07%), including 15 cases of localized pleural adhesion only. Subsequently, we analyzed the characteristics of 70 cases of pleural lesions using thoracoscopy. In two lung cancer patients with pleural metastasis, we found an unusual pleural junction. This connective strip was smooth and free of inflammation, resembling the normal pleura. Conclusion Some of these purely localized pleural adhesions might be attributed to previous inflammation. However, there was still at least a possibility that there must be a physiological pleural junction, which could be the cause of the purely localized pleural adhesion shown in the chest radiograph.

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“…A lung tumor moving independently from the parietal or mediastinal pleura suggests that it does not invade or adhere strongly to the chest wall or pleura. Yamashiro et al 7 . demonstrated that 4DCT had perfect diagnostic accuracy for pleural invasion/adhesion (Sensitivity: 100%, Specificity: 100%) compared to conventional chest CT (Sensitivity: 60%, Specificity: 77%).…”

Section: Introductionmentioning

confidence: 99%

“…A lung tumor moving independently from the parietal or mediastinal pleura suggests that it does not invade or adhere strongly to the chest wall or pleura. Yamashiro et al 7 demonstrated that 4DCT had perfect diagnostic accuracy for pleural invasion/adhesion (Sensitivity: 100%, Specificity: 100%) compared to conventional chest CT (Sensitivity: 60%, Specificity: 77%). Similarly, Sakai et al 9 reported that the sensitivity, specificity, and accuracy of breathing dynamic cine MR in detecting chest wall invasion were 100%, 70%, and 76%, while those of conventional CT and MRI were 80%, 65%, and 68%, respectively.…”

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confidence: 99%

Preoperative assessment of pleural adhesions in patients with lung cancer based on quantitative motion analysis with dynamic chest radiography: A retrospective study

Tanaka

Matsumoto

Takayama

et al. 2023

J Applied Clin Med Phys

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Preoperative assessment of pleural adhesion is crucial for appropriate surgical planning. This study aimed to quantitatively evaluate the usefulness of motion analysis using dynamic chest radiography (DCR) for assessing pleural adhesions. Methods: Sequential chest radiographs of 146 lung cancer patients with or without pleural adhesions (n = 25/121) were obtained using a DCR system during respiration (registration number: 1729). The local motion vector was measured, and the percentage of poor motion area to the maximum expiration lung area (%lung area with poor motion) was calculated. Subsequently, percentage values ≥49.0% were considered to indicate pleural adhesions. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the prediction performance. The percentage of lung area with poor motion was compared between patients with and without pleural adhesions (p < 0.05). Results: DCR-based motion analysis correctly predicted pleural adhesions in 21 out of 25 patients, with 47 false-positive results (sensitivity, 84.0%; specificity, 61.2%; PPV, 30.9%; NPV, 94.9%). The lung with pleural adhesions showed a significantly greater %lung area with poor motion than the opposite lung in the same patient,similar to the cancerous lung in patients without pleural adhesions. Conclusion: On DCR-based motion analysis, pleural adhesions could be indicated by an increase in the percentage of lung area with poor motion. Although the proposed method cannot identify the exact location of pleural adhesions, information regarding the presence or absence of pleural adhesions provided by DCR would help surgeons prepare for challenging surgeries and obtain informed consent from patients. K E Y W O R D S digital radiography, lung cancer, motion analysis, pleural adhesions INTRODUCTIONVideo-assisted thoracoscopic surgery, a less invasive and well-established approach for the surgical resectionThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Preoperative assessment of localized pleural adhesion: Utility of software-assisted analysis on dynamic-ventilation computed tomography

Cited by 8 publications

References 30 publications

Feasibility and safety of secondary video‐assisted thoracoscopic surgery for ipsilateral lung cancer after prior pulmonary resection

Feasibility and safety of secondary video‐assisted thoracoscopic surgery for ipsilateral lung cancer after prior pulmonary resection

The Intrapleural Bridge Connection is One of the Reasons for Unknown Localized Pleural Adhesion

Preoperative assessment of pleural adhesions in patients with lung cancer based on quantitative motion analysis with dynamic chest radiography: A retrospective study

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