Missed pulmonary metastasis

Abstract

Objective

To assess the rate of detection of pulmonary nodules on preoperative computed tomography, based on intraoperative palpation of non-imaged pulmonary nodules, in patients who underwent thoracotomy for metastasectomy with bimanual lung palpation.

Methods

A retrospective study carried out on all cases of pulmonary metastasectomy performed in King Faisal Specialist Hospital and Research Center over a 10-year period (2001–2011). The number of nodules detected on preoperative computed tomography by a radiologist was compared with the number of nodules identified on pathology. Resected pulmonary nodules were classified to benign or malignant. Secondary outcomes were operative approach and primary malignancy.

Results

215 metastasectomies were performed by thoracotomy. The incidence of nodules that were not imaged preoperatively was 36% (41% of mesenchymal tumors, 28% of epithelial tumors).

Conclusion

Metastasectomy by an open approach, which affords bimanual palpation of the entire lung, discovered ipsilateral non-imaged malignant pulmonary metastases in 36% of cases (41% of mesenchymal tumors).

Keywords

Diagnostic errors lung neoplasms pulmonary surgical procedures radiographic image enhancement tomography X-ray computed

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