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J Thorac Cardiovasc Surg 2009;138:837-842
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Intraoperative ultrasonographic localization of pulmonary ground-glass opacities

Ryoichi Kondo, MD, PhDa,*, Kazuo Yoshida, MD, PhDa, Kazutoshi Hamanaka, MDa, Masahiro Hashizume, MDa, Toshiki Ushiyama, MDa, Akira Hyogotani, MDa, Makoto Kurai, MDa, Satoshi Kawakami, MDb, Mana Fukushima, MDc, Jun Amano, MD, PhDa

a Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
b Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
c Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan

Received for publication May 28, 2008; revisions received December 20, 2008; accepted for publication February 2, 2009.

* Address for reprints: Ryoichi Kondo, MD, PhD, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan. (Email: kryoichi{at}shinshu-u.ac.jp).

Objectives: Ground-glass opacities are typically difficult to inspect and to palpate during video-assisted thoracic surgery. We therefore examined whether ultrasonographic assessments could localize ground-glass opacities and help to achieve adequate resection margins.

Methods: An intraoperative ultrasonographic procedure was prospectively performed on 44 patients harboring ground-glass opacities of less than 20 mm in diameter to localize these lesions and to achieve adequate margins. We also examined whether there were any complications resulting from the intraoperative ultrasonogram, such as lung injury, heart injury, or arrhythmia. We excluded patients with both asthma and chronic obstructive pulmonary disease from this study inasmuch as the intraoperative ultrasonographic procedure is more difficult to interpret when residual air is present in the lung.

Results: A total of 53 ground-glass opacities were successfully identified by intraoperative ultrasonography without any complications. Of the 20 mixed ground-glass opacities that we examined, 15 were found on palpation. However, only 4 (12.1%) of the 33 pure ground-glass opacities could be palpated. In all instances in which complete collapse of the lung was achieved (30/53 of these cases), high-quality echo images were obtained. Additionally, a strong correlation was found between the resection margins measured by ultrasonogram and the margins determined by histologic examination in the resected lung specimens (r 2 = 0.954, P < .001).

Conclusions: Intraoperative ultrasonography can both safely and effectively localize pulmonary ground-glass opacities in a completely deflated lung. This procedure is also useful for the evaluation of surgical margins in a resected lung. Hence, ultrasonography may assist surgeons to perform minimally invasive lung resections with clear surgical margins during the treatment of solitary lung ground-glass opacity.

Abbreviations and Acronyms CT = computed tomography; GGO = ground-glass opacity; IU = intraoperative ultrasonography; VATS = video-assisted thoracic surgery






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