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Non-imaged pulmonary nodules discovered during thoracotomy for metastasectomy by lung palpation
European Journal of Cardio-Thoracic Surgery, 05/04/09

Cerfolioa RJ et al. – Findings imply that metastasectomy via open thoracotomy, which affords bi-manual lung palpation of the entire ipsilateral lung, may discover non-imaged malignant pulmonary metastases in 18% of patients who have had a previously treated solid organ cancer and have at least one imaged metastatic lesion in the lung.

Methods

A retrospective study on pts with lesions defined as ‘VATA-able’ who underwent open metastasectomy via thoracotomy
All pts underwent 64-slice helical CT scan with intravenous contrast using 5 mm cuts and integrated FDG-PET/CT
Unsuspected malignant pulmonary nodules that were palpitated and removed, and were not imaged pre operatively were defined as ‘malignant nodules’ and would have been missed by VATS metastasectomy

Results

57 pts had ‘VAT-able’ metastatic pulmonary lesions that were resected via thoracotomy by 1 thoracic surgeon
37% pts had non-imaged pulmonary nodules that were discovered only by bi-manual palpation
They would have been missed by VATS metastasectomy, but these nodules were only malignant in 18% pts
The median size of the non-imaged pulmonary nodule was 0.7 cm
Colorectal carcinoma was the most common tumor requiring metastasectomy
Non-imaged malignant pulmonary nodules were most frequently found in pts with leiyomyosarcoma and osteosarcoma

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