Abstract
Purpose: Ultrasonography is effective at detecting pleural invasion in primary lung cancer, but the factors underlying discordance between findings of pleural invasion according to ultrasonography, gross assessment (PL), and pathological assessment (pl) have not been fully investigated. The aims of the present study were to compare findings from these approaches and identify factors underlying discordant findings. Subjects and Methods: Subjects were 35 patients with primary lung cancer who underwent an ultrasound-guided puncture followed by surgery between 2014 and 2017. We assessed the extent of ultrasonographic pleural invasion prior to the puncture and then evaluated ultrasonographic grading of pleural invasion (uP) by lung cancer. We compared uP, PL, and pl, and examined various factors in patients with concordant findings, overestimated pleural invasion, and underestimated pleural invasion. Results: The rates of agreement between uP and PL, uP and pl, and PL and pl were 34.3%, 28.6%, and 54.3%, respectively. In the uP and PL group, the percentage of interstitial changes significantly increased (P＝0.006) and that of emphysematous changes significantly decreased (P＝0.023) in patients with overestimated pleural invasion. The percentage of pleural irregularities around the tumor on chest CT scan tended to increase in patients with overestimated pleural invasion and interstitial changes (P＝0.066) compared to that in patients with concordant findings and interstitial changes. In the uP and pl group, the percentage of tumors in the apex of the lung significantly increased (P＝0.022) in patients with underestimated pleural invasion. In the uP2 and pl group, the percentage of tumors located near the diaphragm significantly increased (P＝0.024) in patients with overestimated pleural invasion. Conclusion: Interstitial changes, tumors in the apex of the lung, and those located near the diaphragm can affect the assessment of pleural invasion using chest ultrasound.
