Second Place Tie Residents' Competition: Comparison of pulmonary nodule detection rates between preoperative CT imaging and intraoperative lung palpation

Michelle C. Ellis, Crystal J. Hessman, Roshanthi Weerasinghe, Paul H. Schipper, John T. Vetto

    Research output: Contribution to journalArticle

    36 Scopus citations


    Background: Recent advances in computed tomographic (CT) imaging have improved the detection rate of pulmonary metastasis. The aim of this study was to test the hypothesis that the pulmonary nodule detection rate for preoperative CT imaging and intraoperative palpation are now equivalent. Methods: A retrospective review of 108 pulmonary metastasectomies in 84 patients was performed. The number of nodules detected on preoperative CT imaging by radiologist report was compared with the number of malignant nodules identified on pathology. Secondary outcome measures were operative approach and primary malignancy. Results: Sarcoma metastases were the most common indication for resection (n = 54 [50%]). Thirty-three percent of metastasectomies were performed using a thoracoscopic approach. When thoracotomy was used, significantly more nodules were palpated and resected than were identified on preoperative CT imaging (3.24 vs 2.12, P < .001). Significantly more of these nodules were confirmed malignant on final pathology (2.40 vs 1.60, P = .01). This difference was not seen for thoracoscopic resections. Conclusions: Although the sensitivity of CT imaging has improved, a significant number of malignant pulmonary nodules are detected intraoperatively that are not identified on preoperative imaging. Patients undergoing pulmonary metastasectomy require careful intraoperative palpation of lung parenchyma, and therefore open thoracotomy remains the standard of care.

    Original languageEnglish (US)
    Pages (from-to)619-622
    Number of pages4
    JournalAmerican journal of surgery
    Issue number5
    StatePublished - May 2011



    • CT imaging
    • Pulmonary metastasectomy
    • Thoracoscopy

    ASJC Scopus subject areas

    • Surgery

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