RESUMO
BACKGROUND: The surface topography index (STI) has great potential in both routine computed tomography (CT) scan and emerging optical imaging systems. However, the diagnostic accuracy and stability of the STI as a deformity severity assessment index has not been fully confirmed. Therefore, the aim of the present study was to determine the diagnostic performance of the STI as a novel deformity severity assessment index for pectus excavatum. METHODS: The present study consisted of 722 chest CT images from a single center. The standard CT index (CTI) and STI were calculated for all patients. The between-group difference and the level of compliance between the CTI and STI was analyzed by t-test and Pearson correlation. The diagnostic value and optimum discriminatory values of the CTI and STI were calculated by a receiver-operating characteristic (ROC) curve and DeLong's test. RESULTS: The distributions of the CTI and STI were similar and showed a slight overlap between the pectus excavatum (PE) and non-PE groups. Both the CTI and STI significantly differed between the 2 groups (P<0.001). The STI demonstrated a strong Pearson correlation with the CTI (r=0.91, 95% confidence interval: 0.88-0.91, P<0.001). The ROC curves showed that STI =1.58 (sensitivity: 0.93, specificity: 0.95) could be considered equivalent to CTI =2.72 (sensitivity: 0.93, specificity: 0.97) as the optimum discriminatory values. DeLong's test showed no significant difference in the ROC curve results between the CTI and STI (Z=0.90, P=0.37). CONCLUSIONS: The STI has comparative discrimination ability in PE diagnosis and deformity severity assessment when used with the standard CTI. The STI as a novel index is not only an ideal evaluation metric of PE deformity but also an objective trait for PE patients just as weight and height for everyone.
RESUMO
BACKGROUND: Severe pectus excavatum (PE) may be concomitant with congenital cystic lung lesions (CCLLs) that also require surgery. It is ideal to correct these two deformities concurrently, but the safety and efficacy of a simultaneous surgical technique remain unknown. METHODS: Between 2007 and 2017, 635 patients with severe PE were admitted at our medical center. Eight patients underwent minimally invasive repair of PE and lobectomy simultaneously. The patient characteristics and operative data were analyzed and compared with another group of patients who underwent lobectomy alone for contemporaneous CCLLs. RESULTS: The severity of PE (mean Haller index 5.70) and CCLLs were confirmed by computed tomography (CT). Simultaneous minimally invasive repair and lobectomy were performed successfully. There were no significant differences in the mean blood loss (14 mL/kg), the mean weaning time from mechanical ventilation (900 minutes) and the mean hospital stay (16 days) (P>0.05). The mean operative time (170 minutes) was extended, as expected (P=0.02). With a mean follow-up of 22 months, the overall cosmetic results were good. CONCLUSIONS: Simultaneous minimally invasive repair and lobectomy appears to be a technically safe and reliable method for the treatment of concurrent PE and CCLLs, although further studies are needed in the long-term follow-up.
