Chest

Chest

Volume 115, Issue 2, February 1999, Pages 423-427
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Clinical Investigations
EPIDEMIOLOGY AND DIAGNOSIS
Accuracy of CT for the Detection of Pleural Adhesions: Correlation With Video-Assisted Thoracoscopic Surgery

https://doi.org/10.1378/chest.115.2.423Get rights and content

Study objective

The presence of pleural adhesions may render video-assisted thoracoscopic surgery (VATS) difficult or impossible. The aim of this study was to assess the value of chest CT in the detection of pleural adhesions prior to VATS.

Design

Prospective study of the accuracy of chest CT in detecting pleural adhesions prior to VATS.

Setting

Tertiary-referral teaching hospital and Veterans Administration hospital.

Patients

Between July 1994 and March 1995, 63 consecutive patients undergoing 64 VATS procedures were evaluated with chest CT prior to surgery.

Measurements and results

Preoperative scans were interpreted by consensus of two pulmonary radiologists prior to surgery. Suspected pleural adhesions and other findings related to the pleura were recorded on a form given to the surgeon prior to VATS. The surgeon confirmed or excluded each suspected adhesion during VATS, and documented any other lesions not identified preoperatively. Patient-by-patient and lesion-by-lesion analyses were performed. Pleural adhesions were correctly identified by CT in 28 of 39 cases (sensitivity, 71%) and excluded in 18 of 25 cases (specificity, 72%). On a lesion-by-lesion basis, 73 adhesions were identified during VATS, of which only 28 were identified prospectively at CT. There were 45 missed adhesions and 20 adhesions that were suggested falsely (sensitivity, 38%; specificity, 46%). Eighteen pleural spaces were correctly identified as being free of pleural adhesions.

Conclusions

CT is moderately sensitive and specific for preoperative identification of pleural adhesions in patients undergoing VATS but its accuracy is poorer for individual lesions.

Section snippets

Materials and Methods

The study population consisted of 63 consecutive patients with available CT scans who were referred to the thoracic surgeon (MJK) and presented between July 1994 and March 1995. Sixty-four thoracoscopic procedures were performed because one patient had a metastatectomy performed on each lung at separate operations, and had separate CT scans performed prior to each VATS procedure. There were 41 men and 22 women, with a mean age of 54 years (range, 23 to 82 years). The indications for the 64 VATS

Patient-by-Patient Analysis

Eighteen pleural spaces were correctly predicted to be free of adhesions (true negatives). In 28 patients, CT correctly suggested the presence of adhesions in the operated pleural space. Seven patients had one or more adhesions that were suggested by CT but could not be confirmed during VATS. In 11 patients, one or more adhesions were seen during VATS but the CT of the pleura was deemed to be normal. These results yield a sensitivity of 71% and a specificity of 72% for CT in detecting adhesions

Discussion

The detection of pleural adhesions prior to surgery has received little attention in the radiology literature. Hansell and Strickland9 made brief reference to HRCT detection of adhesions in cystic fibrosis patients and possible complications at lung transplantation caused by adhesions. More recently, it has become clear that even the presence of severe pleural adhesions does not preclude lung transplantation because of newer techniques, including the “clam-shell” incision.10 However, adhesions

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†

Dr. Miller is retired.

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Copyright © 1999 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.