Diagnostic Value Of Video-assisted Thoracoscopic Surgery(VATS): Comparison With Clinical And Radiological Diagnosis

ObjectiveTo sum up the experience and comprehending of video-assisted thoracoscopic surgery(VATS) in the diagnosis of pulmonary nodules,comparison with clinical and radiological diagnosis.To determine overall and disease-related accuracy of the clinical/imagiological evaluation for pulmonary infiltrates of unknown aetiology,compared with the pathological result of the surgical lung biopsy (SLB) and to evaluate the need for the latter in this setting.MethodsWe conducted a retrospective review of the experiences of VATS in 65 consecutive patients during the past 6 years. The presumptive diagnosis was based on clinical,imagiological and non-invasive or minimally invasive diagnostic procedures and compared with the gold standard of histological diagnosis by VATS. We considered four major pathological groups: infectious disease ,pneumonophthisis ,primitive neoplasms and metastases. Patients with previous histological diagnosis were excluded.ResultsAll the operations were successfully accomplished and no complications or deaths occurred during perioperative. There are 41 cases of benign lesions in 65 cases, including 8 cases for inflammatory pseudotumor, 6 cases for hamartoma, 5 cases for inflammatory mass, 3 cases for pulmonary cryptococcosis, 2 cases for pulmonary aspergillosis, 1 case for idiopathic pulmonary hemosiderosis , 1 case for bronchiectasis, 1 case for lung cyst, 1 case for pulmonany angioma and1 case for lung fibroma; 12 cases for pneumonophthisis ; 21 cases for lung cancer, including 11 cases for bronchioalveolar carcinoma ,3 cases for adenocarcinoma,3 cases for squamous cell carcinoma,2 cases for large cell carcinoma,2 cases for mixed carcinoma ;3 cases for metastatic tumor. 46 patients were operated by pulmonary wedge resectuin through VATS, pulmonary lobectomy was performed by VAMT and mediastinal lymph node dissection. In 61.5% of patients(n=40) clinical evaluation reached a correct diagnosis, in 38.5% a new diagnosis was established (n=25) by the VATS. The pre-test probability for each disease was 65% for infectious disease , 50% for pneumonophthisis 60% for primitive neoplasms and 100% for metastases. Overall sensitivity, specificity, positive and negative predictive values for the clinical/radiological diagnosis were 62% ,86%,69% and 78%, respectively. For infectious disease:65%,84%,65% and 84%; pneumonophthisis:50%,91%,60% and 87%; primitive neoplasms:60%,84%,78% and 69%; metastases 100%,94%,43% and 100%。ConclusionsVATS has obviously small wound with hight diagnosis rate, small trauma and quickly recovery from sugery .Despite a high sensitivity and specificity of the clinical and imagiological diagnosis, the positive predictive value was low, particularly in the malignancy group. SLB should be performed in pulmonary infiltrates of unknown aetiology because the clinical/imagiological assessment missed and /or misdiagnosed an important number of patients.