Intraoperatory echography in the detection of the metastatic lung nodules

The lung is the second commonest organ affected by metastatic disease. Bimanual examination is considered the most reliable diagnostic method so far. Recurrent metastatic disease and the need for repeated surgical procedures have prompt development of new diagnostic methods. We introduced intraoperative ultrasound as a way of diagnoses lung metastastasis in patients that fulfilled inclusion requirements and were submitted to metastasectomy between august 1997 and may 1998. By means of a conventional surgical approach a bimanual examination of the collapsed lung was practiced. Next, the ultrasound examination was done after filling the pleural cavity with normal saline solution; we used a multipurpose 7.5 MHz. sectorial transducer. All the lesions detected by both methods were identified and their size and location were registered. In all cases a cuneiform lung resection and pathological study were practiced. The study included 11 patients, six were men (55%) and five women (45%). finally, 50 nodes were retrieved. the surgeon detected 35 nodes (78%) and ultrasound 45(90%). at last, 42 nodes were reported as metastatic. among these 27 (64%) were located by the surgeon in comparison with 42 (100%) seen in the ultrasound examination. Ultrasound diagnosed 13 nodes with less then 5 mm (29.5%) against 2 (7.5%) detected by the surgeon. this was statistically significant (chi square), 1 gr.1 =7.2: p 0.007) the average time for the performance of the ultrasound examination was 9 minutes (range 5 to 15 minutes)