Preoperative Chest Computed Tomography Research Articles

Incidental lung carcinoma detected at CT in patients selected for lung volume reduction surgery to treat severe pulmonary emphysema.

The authors present their experience with previously unsuspected carcinoma of the lung detected at preoperative computed tomography (CT) in patients with severe pulmonary emphysema who were scheduled to undergo lung volume reduction surgery. Preoperative chest CT was performed in 148 patients (84 men, 64 women; mean age, 65 years +/- 8 [standard deviation]) with advanced pulmonary emphysema before lung volume reduction surgery. At surgery, an attempt was made to excise any pulmonary nodule considered suspicious for carcinoma at CT. Eighteen pulmonary nodules suspicious for lung cancer were found at CT in 17 (11%) of the 148 patients. Sixteen of these 148 nodules were resected at lung volume reduction surgery. Nine non-small cell carcinomas (adenocarcinoma, n = 4, including three with bronchioloalveolar differentiation; poorly differentiated, n = 3; squamous cell carcinoma, n = 2) were found in eight (5%) patients. Eight of the cancers were stage I, and one was unstaged surgically. Maximum diameters of the cancers ranged between 1.0 and 3.8 cm (median, 1.6 cm). The seven (5%) other resected nodules were all benign. A 5% rate of stage I primary lung cancer in patients selected for lung volume reduction surgery suggests that performance of chest CT in candidates for lung volume reduction surgery is appropriate not only to identify patterns of pulmonary parenchymal destruction but also to search for stage I lung cancer.

Assessment of the accuracy of diagnostic chest CT scanning. Impact on lung cancer management: Cangemi V, Volpino P, Drudi FM, D'Andrea N, Cangemi R, Piat G. 1st Department of Clinical Surgery, Special Service Diagnostic Surgery, University of Rome ‘La Sapienza’, Rome. Int Surg 1996;81:77–82

To evaluate the reliability of computed tomography (CT) scanning in detecting the locoregional extent of bronchogenic carcinoma, preoperative chest CT findings were compared with surgical and pathological findings (pTN) in 61 patients submitted to pulmonary resection for non-small cell lung carcinoma. Neoplastic disease was misdiagnosed in 3 cases. In the remaining 58 cases, CT showed a sensitivity, specificity and accuracy in delineating T factor of 66.6%, 96.1%, 93.1% for T1; of 84.6%, 68.4%, 79.3% for T2; of 66.6%, 95.9%, 91.3% for T3 and of 50.0%, 94.4%, 91.3% for T4. For N1 and N2 factors, sensitivity was 45.4% and 27.2%; and accuracy was 74.1% and 81.0% respectively. The highest incidence of false positive N1 and false positive N2 was found in tumors classified at CT as T2 and T4 respectively. Overall CT showed a good accuracy in discriminating between resectable tumours with better prognosis (postsurgical pathological stage I-II) and those with less favourable outcome (postsurgical pathological stage III).

Preoperative Computed Tomography for Transhiatal Esophagectomy

We report the results of a retrospective evaluation of preoperative chest computed tomography (CT) in 50 consecutive patients with esophageal carcinoma confirmed surgically. Forty patients underwent transhiatal esophagectomy without thoracotomy. In ten cases, blunt dissection of the esophageal carcinoma was impossible because of involvement of an adjacent organ. Transhiatal esophagectomy carries lower morbidity and mortality rates than the standard thoracotomy procedure, although long-term survival is considered to be the same with either method. The overall sensitivity of CT in detecting involvement of an adjacent organ, thus contraindicating the transhiatal procedure, was 90%, with an overall specificity of 92%. The positive predictive value was 75%, and the negative predictive value 89%. The negative predictive value of CT for tracheobronchial invasion, the main surgical risk in the transhiatal procedure, was 90%. A negative preoperative CT appears to be a reliable indicator for patients undergoing transhiatal esophagectomy.