Preoperative ultrasound reveals NSCLC chest wall invasion

By Lynda Williams, Senior medwireNews Reporter

Surgeon-performed ultrasound (US) is a good alternative to computed tomography (CT) for the identification of chest wall invasion in patients with non-small-cell lung cancer (NSCLC), suggests research demonstrating 90% sensitivity for detection of the spread.

Although preoperative CT is used to estimate parietal pleura or chest wall invasion – an important marker in the Tumour Node Metastasis staging model – the imaging mode has poor sensitivity and accuracy, explain Moishe Liberman and co-workers, from the University of Montreal in Quebec, Canada.

Hypothesising that transthoracic US could give real-time imaging of the main NSCLC and the chest wall, the team compared the technique with CT in 15 men and 13 women, aged an average of 62 years, who were scheduled to undergo resection. US took an average of 5.3 minutes to perform.

Compared with final pathological analysis, surgeon-performed US was found to be 90.9% sensitive and 85.7% specific for the identification of chest wall invasion, with positive and negative predictive values of 83.3% and 92.3%, respectively.

By comparison, CT sensitivity was just 61.5% and specificity 84.6%, with positive and negative predictive values of 80.0% and 68.8%, respectively.

Among patients with pathologically proven chest wall invasion, US revealed interruption of the parietal pleura in 90.9% of patients, rib invasion in 72.7% and an absence of movement on respiration in 90.9%, the researchers report in the Annals of Thoracic Surgery.

Liberman et al say that the study’s findings have “important clinical consequences” for patients with suspected chest wall invasion.

“Diagnosing chest wall invasion with high accuracy allows for precise preoperative diagnosis and staging of the T stage of the cancer”, they write, noting that such information could be used to guide a surgeon’s choice of surgical incision, operative approach and anaesthesia plan.

“The surgeon and the patient can therefore go into the operating room with better information about the stage of the disease and the surgical procedure and approach.”

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