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：

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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

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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.
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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.	吳衛兵, 夏陽, 許晶, 等. 3D導航胸腔鏡聯合肺亞段切除術治療肺段間結節的對比研究. 南京醫科大學學報(自然科學版), 2018, 38(10): 1424-1427.
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9.	王宗凱, 葛明建. 亞肺葉切除術治療早期非小細胞肺癌時肺切緣的研究進展. 中國肺癌雜志, 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.	李響, 朱燚寧, 吳衛兵, 等. 肺結節三維空間位置判定方法及臨床意義. 中國胸心血管外科臨床雜志, 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.	蔣希, 袁奕萱, 王雅萍, 等. 中國醫學影像人工智能20年回顧和展望. 中國圖象圖形學報, 2022, 27(3): 655-671.
19.	劉艷東, 程曉光, 于愛紅. 基于深度學習的人工智能在肌骨影像中的研究進展. 醫學影像學雜志, 2022, 32(2): 339-341.
20.	李忠, 林麗景, 張敏輝, 等. 基層醫院開展胸腔鏡下解剖性肺段切除23例報告. 中國醫藥科學, 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. 姜格寧, 陳昶, 朱余明, 等. 上海市肺科醫院磨玻璃結節早期肺腺癌的診療共識(第一版). 中國肺癌雜志, 2018, 21(3): 147-159.
5. 黃晶晶, 陳志鵬, 卞承禹, 等. 以肺亞段為解剖單元的肺結節手術策略及臨床結果的單中心回顧性分析. 中國胸心血管外科臨床雜志, 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. 吳衛兵, 夏陽, 許晶, 等. 3D導航胸腔鏡聯合肺亞段切除術治療肺段間結節的對比研究. 南京醫科大學學報(自然科學版), 2018, 38(10): 1424-1427.
8. 陳亮, 朱全, 吳衛兵, 等. 胸腔鏡解剖性肺亞段切除手術圖譜. 南京: 東南大學出版社, 2021.
9. 王宗凱, 葛明建. 亞肺葉切除術治療早期非小細胞肺癌時肺切緣的研究進展. 中國肺癌雜志, 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. 李響, 朱燚寧, 吳衛兵, 等. 肺結節三維空間位置判定方法及臨床意義. 中國胸心血管外科臨床雜志, 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. 蔣希, 袁奕萱, 王雅萍, 等. 中國醫學影像人工智能20年回顧和展望. 中國圖象圖形學報, 2022, 27(3): 655-671.
19. 劉艷東, 程曉光, 于愛紅. 基于深度學習的人工智能在肌骨影像中的研究進展. 醫學影像學雜志, 2022, 32(2): 339-341.
20. 李忠, 林麗景, 張敏輝, 等. 基層醫院開展胸腔鏡下解剖性肺段切除23例報告. 中國醫藥科學, 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

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