Intraoperative diagnosis of pleural invasion of lung cancer patients: Evaluation of accuracy

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  • 肺癌の術中胸膜浸潤診断の正確性についての検討

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Since lung cancer patients with visceral pleural invasion show a poorer prognosis even with a tumor size of 2 cm or smaller, these patients are not suitable candidates for sublobar resection. Therefore, we evaluated the accuracy of the intraoperative diagnosis of visceral pleural invasion. Twelve doctors who belong to the Department of Thoracic Surgery answered clinical questions and the data were collected. Of the 30 eligible patients who showed pleural changes, 14 were male and 16 were female, and the mean age was 66.8 years (range, 41-81 years). The mean tumor size was 22.7 mm (range, 16-57 mm). The histologic type was adenocarcinoma in 22 patients, squamous cell carcinoma in 7 patients, and another cell type in 1 patient. There were 22 patients with (pl 1≤) and 8 patients without (pl 0) visceral pleural invasion. The doctors were given the following information: 1. Preoperative CT, 2. Histologic type, and 3. Thoracoscopic movies showing pleural changes, and they answered whether or not there was visceral pleural invasion (PL≤1 or PL 0). Sensitivity, specificity, and accuracy were calculated from the data. The overall average sensitivity, specificity, and accuracy were 66.7% (range, 37.5-87.5%), 61.4% (range, 45.5-86.4%), and 62.8% (range, 53.3-80.0%), respectively. The accuracy of intraoperative diagnosis for visceral pleural invasion is not high; therefore, novel diagnostic procedures are expected in the future.

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