Thoracoscopic Resection of Congenital Lung Malformation: Looking for the Right Preoperative Assessment
Introduction Consensus on the best postnatal radiological evaluation of congenital lung malformations (CLMs) is still lacking. In recent years, the interest on magnetic resonance imaging (MRI) has grown, but its role is still unknown.
Aim The aim of the study was to identify the best preoperative diagnostic assessment for CLM.
Materials and Methods All patients with a prenatal suspicion of CLM between January 2014 and February 2018 were studied. Asymptomatic newborns underwent MRI, during spontaneous sleep without contrast. Patients with a positive MRI were scheduled for computed tomography (CT) within the fourth month of life. Thoracoscopic resection was performed in cases with a pathological CT. MRI, CT, and surgical findings were compared based on dimension, localization, and features of the CLM using the Cohen's kappa test (K).
Results A total of 20 patients were included (10 males). No difference was found in the diameter and site of the lesions always localized in the same side (K = 1) and in the same pulmonary lobe (K = 1). Infants who underwent thoracoscopic resection included: three congenital pulmonary airway malformations (CPAMs), five extralobar and eight intralobar sequestrations (bronchopulmonary sequestrations [BPSs]), three bronchogenic cysts, and one congenital emphysema. The concordance between MRI and CT and between radiological investigations and pathology was satisfactory for the greatest part of the studied variables. MRI showed sensitivity of 100%, specificity of 82%, positive predictive value of 50% and negative predictive value of 100% for CPAM and 77, 100, 100, and 80% for BPS, respectively.
Conclusion MRI proved to be a reliable diagnostic investigation for CLM with high sensitivity and specificity. Early MRI in spontaneous sleep without contrast and preoperative contrast CT scan is a valuable preoperatory assessment.
Keywordscongenital lung malformations - thoracoscopy - magnetic resonance imaging - computed tomography scan
Received: 16 April 2019
Accepted: 26 July 2019
06 October 2019 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Stuttgart · New York
- 1 Epelman M, Kreiger PA, Servaes S, Victoria T, Hellinger JC. Current imaging of prenatally diagnosed congenital lung lesions. Semin Ultrasound CT MR 2010; 31 (02) 141-157
- 2 Chowdhury MM, Chakraborty S. Imaging of congenital lung malformations. Semin Pediatr Surg 2015; 24 (04) 168-175
- 3 Ohno Y, Kauczor HU, Hatabu H, Seo JB, van Beek EJR. International Workshop for Pulmonary Functional Imaging (IWPFI). MRI for solitary pulmonary nodule and mass assessment: current state of the art. J Magn Reson Imaging 2018; 47 (06) 1437-1458
- 4 Zirpoli S, Munari AM, Primolevo A. , et al. Agreement between magnetic resonance imaging and computed tomography in the postnatal evaluation of congenital lung malformations: a pilot study. Eur Radiol 2019; 29 (09) 4544-4554
- 5 Chakraborty RK, Sharma S. Pulmonary Sequestration. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019
- 6 Kapralik J, Wayne C, Chan E, Nasr A. Surgical versus conservative management of congenital pulmonary airway malformation in children: a systematic review and meta-analysis. J Pediatr Surg 2016; 51 (03) 508-512
- 7 Kyncl M, Koci M, Ptackova L. , et al. Congenital bronchopulmonary malformation: CT histopathological correlation. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016; 160 (04) 533-537
- 8 Calvert JK, Lakhoo K. Antenatally suspected congenital cystic adenomatoid malformation of the lung: postnatal investigation and timing of surgery. J Pediatr Surg 2007; 42 (02) 411-414
- 9 Nasr A, Himidan S, Pastor AC, Taylor G, Kim PC. Is congenital cystic adenomatoid malformation a premalignant lesion for pleuropulmonary blastoma?. J Pediatr Surg 2010; 45 (06) 1086-1089
- 10 Criss CN, Musili N, Matusko N, Baker S, Geiger JD, Kunisaki SM. Asymptomatic congenital lung malformations: is nonoperative management a viable alternative?. J Pediatr Surg 2018; 53 (06) 1092-1097
- 11 Downard CD, Calkins CM, Williams RF. , et al. Treatment of congenital pulmonary airway malformations: a systematic review from the APSA outcomes and evidence based practice committee. Pediatr Surg Int 2017; 33 (09) 939-953
- 12 Rothenberg SS, Middlesworth W, Kadennhe-Chiweshe A. , et al. Two decades of experience with thoracoscopic lobectomy in infants and children: standardizing techniques for advanced thoracoscopic surgery. J Laparoendosc Adv Surg Tech A 2015; 25 (05) 423-428
- 13 Hammond PJ, Devdas JM, Ray B, Ward-Platt M, Barrett AM, McKean M. The outcome of expectant management of congenital cystic adenomatoid malformations (CCAM) of the lung. Eur J Pediatr Surg 2010; 20 (03) 145-149
- 14 Hubbard AM, Crombleholme TM, Adzick NS. , et al. Prenatal MRI evaluation of congenital diaphragmatic hernia. Am J Perinatol 1999; 16 (08) 407-413
- 15 Cannie M, Jani J, De Keyzer F. , et al. Magnetic resonance imaging of the fetal lung: a pictorial essay. Eur Radiol 2008; 18 (07) 1364-1374
- 16 Alamo L, Reinberg O, Vial Y, Gudinchet F, Meuli R. Comparison of foetal US and MRI in the characterisation of congenital lung anomalies. Eur J Radiol 2013; 82 (12) e860-e866
- 17 Sodhi KS, Khandelwal N, Saxena AK. , et al. Rapid lung MRI in children with pulmonary infections: time to change our diagnostic algorithms. J Magn Reson Imaging 2016; 43 (05) 1196-1206
- 18 Dournes G, Menut F, Macey J. , et al. Lung morphology assessment of cystic fibrosis using MRI with ultra-short echo time at submillimeter spatial resolution. Eur Radiol 2016; 26 (11) 3811-3820
- 19 Biederer J, Mirsadraee S, Beer M. , et al. MRI of the lung (3/3)-current applications and future perspectives. Insights Imaging 2012; 3 (04) 373-386
- 20 Wild JM, Marshall H, Bock M. , et al. MRI of the lung (1/3): methods. Insights Imaging 2012; 3 (04) 345-353
- 21 Narayan RR, Abadilla N, Greenberg DR. , et al. Predicting pathology from imaging in children undergoing resection of congenital lung lesions. J Surg Res 2019; 236: 68-73