Intraoperative Ultrasonography Detection Of Pulmonary Nodules By Video-assisted Thoracoscopic Surgery

Objective: A comparative study of preoperative HRCT and intraoperative ultrasound images on pulmonary nodules undergoing VATS surgery was conducted to explore the clinical application values of intraoperative ultrasound for detection and localization of pulmonary nodules by video-assisted thoracoscopic surgery.Materials and Methods: Collected from January 2019 to May 2019,39 cases of pulmonary nodular lesions treated with VATS in Cancer Hospital of China Medical University(Liaoning Cancer Hospital & Institutes)were treated,including 13 males and 26 females;aged 35-78 years old.The average age is 60.18 ± 9.81 years.Chest high-resolution computed tomography(HRCT)examination was performed within 1 week before surgery;VATS intraoperative ultrasound examination was performed during the operation.The preoperative HRCT examination used Philips 256 iCT,TOSHIBA Aquilion ONE CT,and the scanning range was from the lung tip to the lung base.Two experienced radiologists independently evaluated and detected the number,shape,edge,CT value and the maximum diameter of the lesions,and clarified the approximate anatomical location of the lung lobe.Intraoperative ultrasound examination used BK Pro Focus 2202 color Doppler ultrasound diagnostic apparatus,equipped with intraoperative ultrasound probe,the probe frequency was 5.5-10.0MHz.Pulmonary nodules were explored by uniportal VATS.When the lung tissue reaches the maximum collapse state during operation,according to the location of the lesion displayed by HRCT before surgery,the clinician performed the operation on the specific surface of the lung from top to bottom and from outside to inside.During the operation,the sonographer observed the ultrasonic performance of the lesion and collected the data.The data of the shape,echo,maximum diameter of the lesion and the distance from the lesion to the pleura were recorded.We summarized the shape and echo characteristics of pulmonary nodules on intraoperative ultrasound images and compared with the shape and CT value of preoperative HRCT.To predict the intraoperative ultrasound application value of the localization of pulmonary nodules,the CT values of preoperative HRCT,intraoperative echo characteristics of the pulmonary nodule,and the distance from the lesion to the pleura were analyzed.SPSS26.0 software was used for analysis.If the normal distribution is consistent,the measurement data were expressed as mean ± standard deviation(x" ± s),and the count data were expressed as n or percentage.Pearson c2 Test or Fisher exact probability test were used for single factor analysis,and logistic regression analysis was used for multi factor analysis.The level of statistical significance was set at P < 0.05.Results:1.There was a significant difference in the shortest distance between malignant and benign pulmonary nodules on the preoperative HRCT image(P < 0.05).2.The difference between the shortest distance of lung nodules and pleura measured on preoperative HRCT images and intraoperative ultrasound images was statistically significant(P < 0.05).3.VATS intraoperatively detected and undetected pulmonary nodules,there was a significant statistical difference between the CT values on HRCT images before surgery(P < 0.05)with the CT value of lesion-338 HU as the distinction between whether the lesion could be detected under intraoperative ultrasound.The critical value of diagnosis was 85.3% for sensitivity,83.3% for specificity,and the area under the curve(AUC)was 0.880.Conclusion: 1.When performing VATS surgery on lung nodules,following the principle similar to the lesion characteristics on HRCT before surgery was conducive to detecting the corresponding lesions on VATS ultrasound images.2.The CT value of pulmonary nodules on preoperative HRCT-338 HU,which can be used as a critical value for predicting the detection of pulmonary nodules by ultrasound during VATS.