Three-dimensional imaging of a specific collateral vein in bilateral upper lung and its clinical significance_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

BIAN Chengyu ¹ , HUANG Jingjing ¹ , MU Guang ¹ , ZHANG Wenhao ¹ , WU Weibing ¹ , XIA Yang ¹ , YUAN Mei ² , CHEN Liang ¹ ,  WANG Jun ¹

1. Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, P. R. China;
2. Department of Imaging, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, P. R. China;

Corresponding author：

WANG Jun, Email: drwangjun@njmu.edu.cn

Keywords：

Pulmonary nodule; 3D CTBA; collateral vein; lobectomy; sublobectomy; artificial intelligence

DOI：

10.7507/1007-4848.202203009

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To analyze the incidence and drainage pattern of the specific collateral vein (VL) located between several adjacent segments of the bilateral upper lung, and its clinical significance in the surgical treatment of early lung cancer. Methods The preoperative three-dimensional computed tomography bronchography and angiography (3D CTBA) data of 1 515 patients in the First Affiliated Hospital of Nanjing Medical University from 2017 to 2020 were analyzed retrospectively, including 524 males and 991 females, with an average age of 54.27±11.43 years. There were 712 patients of right upper lung and 803 patients of left upper lung. The incidence and drainage pattern of VL in bilateral upper lungs were analyzed. Furthermore, the imaging data and medical records of 113 patients in the left upper lung were reviewed to investigate the influence of the relative position relationship between nodules and VL on the selection of operation. Results The overall incidence of VL was 72.7% (1102/1 515) in the bilateral upper lungs, including 68.0% (484/712) in the right upper lung, and 77.0% (618/803) in the left upper lung. The incidence of VL in the left side was significantly higher than that in the right side (P＜0. 05). VL mainly drained into V²a+b (327/484, 67.6%) in the right upper lung and into V¹⁺²b+c (389/618, 62.9%) in the left upper lung. When the spherical simulative cutting margin of 2 cm of the nodule did not involve VL, it was more feasible to undergo sublobectomy than those whose simulative cutting margin of 2 cm involved VL, and the difference was statistically significant (91.9% vs. 61.5%, P＜0.05). When the spherical simulative cutting margin of 2 cm of nodule involved VL, the lesion located in the middle or inner zone was more feasible to undergo lobectomy than that in the outer zone, but the difference was not statistically significant (43.8% vs. 34.8%, P＞0.05). Multivariate logistic regression analysis showed that diameter of the lesion, whether the spherical simulative margin of 2 cm involving VL and the depth ratio of the lesion were independent risk factors affecting the surgical options (P<0.05). Conclusion The incidence of the specific collateral vein in bilateral upper lungs is high, and the drainage pattern is diverse, which has important guiding significance for preoperative planning and intraoperative manipulation. For deep nodules adjacent to VL, lobectomy or resection of left upper division is often performed to ensure a safe margin.

Citation： BIAN Chengyu, HUANG Jingjing, MU Guang, ZHANG Wenhao, WU Weibing, XIA Yang, YUAN Mei, CHEN Liang, WANG Jun. Three-dimensional imaging of a specific collateral vein in bilateral upper lung and its clinical significance. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(7): 859-866. doi: 10.7507/1007-4848.202203009 Copy

1.	Liu A, Wang Z, Yang Y, et al. Preoperative diagnosis of malignant pulmonary nodules in lung cancer screening with a radiomics nomogram. Cancer Commun (Lond), 2020, 40(1): 16-24.
2.	Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
3.	Wu WB, Xia Y, Pan XL, et al. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
4.	姜格宁, 陈昶, 朱余明, 等. 上海市肺科医院磨玻璃结节早期肺腺癌的诊疗共识(第一版). 中国肺癌杂志, 2018, 21(3): 147-159.
5.	黄晶晶, 陈志鹏, 卞承禹, 等. 以肺亚段为解剖单元的肺结节手术策略及临床结果的单中心回顾性分析. 中国胸心血管外科临床杂志, 2022, 29(1): 36-43.
6.	Oizumi H, Kanauchi N, Kato H, et al. Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: A report of 52 consecutive cases. J Thorac Cardiovasc Surg, 2011, 141(3): 678-682.
7.	吴卫兵, 夏阳, 许晶, 等. 3D导航胸腔镜联合肺亚段切除术治疗肺段间结节的对比研究. 南京医科大学学报(自然科学版), 2018, 38(10): 1424-1427.
8.	陈亮, 朱全, 吴卫兵, 等. 胸腔镜解剖性肺亚段切除手术图谱. 南京: 东南大学出版社, 2021.
9.	王宗凯, 葛明建. 亚肺叶切除术治疗早期非小细胞肺癌时肺切缘的研究进展. 中国肺癌杂志, 2018, 21(6): 498-502.
10.	NCCN clinical practice guidelines in oncology: Non-small cell lung cancer (version 1.2020). https://www.nccn.org/.
11.	李响, 朱燚宁, 吴卫兵, 等. 肺结节三维空间位置判定方法及临床意义. 中国胸心血管外科临床杂志, 2021, 28(3): 305-310.
12.	Zhang M, Mao N, Zhang K, et al. Analysis of the variation pattern in left upper division veins and establishment of simplified vein models for anatomical segmentectomy. Ann Transl Med, 2020, 8(22): 1515.
13.	Shimizu K, Nagashima T, Ohtaki Y, et al. Analysis of the variation pattern in right upper pulmonary veins and establishment of simplified vein models for anatomical segmentectomy. Gen Thorac Cardiovasc Surg, 2016, 64(10): 604-611.
14.	Yamashita H. Roentgenologic Anatomy of the Lung. New York: Igaku-Shoin Medical Publisher, 1978.
15.	Boyden EA. Segmental Anatomy of The Lung. New York: McGraw Hill, 1954.
16.	Wang J, Lin H, Bian C, et al. A modified system for classifying the bilateral superior pulmonary veins using three-dimensional computed tomography bronchography and angiography images. J Thorac Dis, 2021, 13(10): 5933-5941.
17.	Hong R, Chen C, Zheng W, et al. "Split" combined subsegmentectomy: A case series. Thorac Cancer, 2022, 13(3): 423-429.
18.	蒋希, 袁奕萱, 王雅萍, 等. 中国医学影像人工智能20年回顾和展望. 中国图象图形学报, 2022, 27(3): 655-671.
19.	刘艳东, 程晓光, 于爱红. 基于深度学习的人工智能在肌骨影像中的研究进展. 医学影像学杂志, 2022, 32(2): 339-341.
20.	李忠, 林丽景, 张敏辉, 等. 基层医院开展胸腔镜下解剖性肺段切除23例报告. 中国医药科学, 2020, 10(16): 176-179.

1. Liu A, Wang Z, Yang Y, et al. Preoperative diagnosis of malignant pulmonary nodules in lung cancer screening with a radiomics nomogram. Cancer Commun (Lond), 2020, 40(1): 16-24.
2. Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
3. Wu WB, Xia Y, Pan XL, et al. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
4. 姜格宁, 陈昶, 朱余明, 等. 上海市肺科医院磨玻璃结节早期肺腺癌的诊疗共识(第一版). 中国肺癌杂志, 2018, 21(3): 147-159.
5. 黄晶晶, 陈志鹏, 卞承禹, 等. 以肺亚段为解剖单元的肺结节手术策略及临床结果的单中心回顾性分析. 中国胸心血管外科临床杂志, 2022, 29(1): 36-43.
6. Oizumi H, Kanauchi N, Kato H, et al. Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: A report of 52 consecutive cases. J Thorac Cardiovasc Surg, 2011, 141(3): 678-682.
7. 吴卫兵, 夏阳, 许晶, 等. 3D导航胸腔镜联合肺亚段切除术治疗肺段间结节的对比研究. 南京医科大学学报(自然科学版), 2018, 38(10): 1424-1427.
8. 陈亮, 朱全, 吴卫兵, 等. 胸腔镜解剖性肺亚段切除手术图谱. 南京: 东南大学出版社, 2021.
9. 王宗凯, 葛明建. 亚肺叶切除术治疗早期非小细胞肺癌时肺切缘的研究进展. 中国肺癌杂志, 2018, 21(6): 498-502.
10. NCCN clinical practice guidelines in oncology: Non-small cell lung cancer (version 1.2020). https://www.nccn.org/.
11. 李响, 朱燚宁, 吴卫兵, 等. 肺结节三维空间位置判定方法及临床意义. 中国胸心血管外科临床杂志, 2021, 28(3): 305-310.
12. Zhang M, Mao N, Zhang K, et al. Analysis of the variation pattern in left upper division veins and establishment of simplified vein models for anatomical segmentectomy. Ann Transl Med, 2020, 8(22): 1515.
13. Shimizu K, Nagashima T, Ohtaki Y, et al. Analysis of the variation pattern in right upper pulmonary veins and establishment of simplified vein models for anatomical segmentectomy. Gen Thorac Cardiovasc Surg, 2016, 64(10): 604-611.
14. Yamashita H. Roentgenologic Anatomy of the Lung. New York: Igaku-Shoin Medical Publisher, 1978.
15. Boyden EA. Segmental Anatomy of The Lung. New York: McGraw Hill, 1954.
16. Wang J, Lin H, Bian C, et al. A modified system for classifying the bilateral superior pulmonary veins using three-dimensional computed tomography bronchography and angiography images. J Thorac Dis, 2021, 13(10): 5933-5941.
17. Hong R, Chen C, Zheng W, et al. "Split" combined subsegmentectomy: A case series. Thorac Cancer, 2022, 13(3): 423-429.
18. 蒋希, 袁奕萱, 王雅萍, 等. 中国医学影像人工智能20年回顾和展望. 中国图象图形学报, 2022, 27(3): 655-671.
19. 刘艳东, 程晓光, 于爱红. 基于深度学习的人工智能在肌骨影像中的研究进展. 医学影像学杂志, 2022, 32(2): 339-341.
20. 李忠, 林丽景, 张敏辉, 等. 基层医院开展胸腔镜下解剖性肺段切除23例报告. 中国医药科学, 2020, 10(16): 176-179.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Three-dimensional imaging of a specific collateral vein in bilateral upper lung and its clinical significance

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content