Intraoperative Surgical Margin Assessment of Sublobar Lung Resection Specimens Using Computed Tomography.

Abstract

While early lung cancers are increasingly managed with sublobar resection, inadequate surgical margin (SM) is still a major concern, increasing the risk of locoregional recurrence. In this study, we evaluated the feasibility of using computed tomography (CT) as an intraoperative SM guidance tool by comparing with histopathologic SM measurement. Patients scheduled for segmentectomy or wedge resection were enrolled. Immediately after resection, lung samples were reinflated and CT images were acquired. SM length, defined as the distance between the tumor and staple line, was measured by both CT and pathology. CT-derived SM length was compared with pathology-derived SM length using Bland-Altman analysis. Factors affecting differences between the 2 measurements were assessed using multiple linear regression analysis. A total of 52 resected specimens were analyzed. There were 34 solid (65.4%) and 18 subsolid tumors (34.6%). The mean SM length by CT and pathology was 11.3 mm and 10.1 mm, respectively. There was overall a 10.6% reduction from CT to pathology (P = .033). In Brand-Altman analysis, the mean difference between SM on CT and pathology was 1.2 mm, with the 95% limits of agreement from -7.2 to 9.6 mm. The multiple linear regression analysis revealed that subsolid tumors (P = .047) and depth from pleura (P < .01) were independent factors affecting SM discrepancy. SM measurement by CT is feasible and has the potential to aid in the evaluation of SM intraoperatively. However, surgeons must anticipate the potentially greater discordance when using this technique for subsolid tumors.