Can computed tomography of the chest stage lung cancer?—Yes and no

doi:10.1016/0003-4975(90)90306-Q

The Annals of Thoracic Surgery

Volume 49, Issue 4, April 1990, Pages 591-596

https://doi.org/10.1016/0003-4975(90)90306-Q Get rights and content

Abstract

To determine the accuracy of computed tomography (CT) of the chest in the staging of lung cancer, we studied 418 patients with primary pulmonary carcinoma between 1979 and 1986. Each had a preoperative scan performed before detailed operative staging. Each CT scan was analyzed for components of the current TNM staging system. Computed tomography sensitivity and specificity for mediastinal lymph node metastasis were 84.4% and 84.1%, with corresponding positive and negative predictive accuracies of 68.7% and 92.9%, respectively. When TNM stages were derived from CT scans, only 190 of 418 (45.4%) completely agreed with operative staging. An additional 53 of 418 (12.7%) predicted the correct stage, although components of the TNM system were incorrect. In 94 of 418 scans (22.5%) CT overestimated the stage, whereas in 81 (19.4%) CT downgraded the stage. Computed tomography suggested metastatic lesions in liver, lung, adrenal gland, bone, or abdominal lymph nodes in 40 of 373 scans (10.7%); only five of 40 (12.5%) had documented metastasis. In summary, CT of the chest cannot accurately stage primary lung carcinoma according to the TNM classification. Because the negative predictive accuracy for mediastinal lymph node metastasis remains high (92.9%), invasive staging can be deferred for definitive thoracotomy when no lymphadenopathy is evident on CT. The high negative predictive accuracy for scans of the chest and upper abdomen makes CT a useful tool for exclusion of metastatic disease.

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Citation Excerpt :
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^☆: Presented at the Twenty-Fifth Anniversary Meeting of The Society of Thoracic Surgeons, Baltimore, MD, Sep 11–13, 1989.

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Original articleCan computed tomography of the chest stage lung cancer?—Yes and no☆

Abstract

Am J Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Chest

J Thorac Cardiovasc Surg

Chest

Am J Surg

Chest

Computed tomography in the preoperative evaluation of bronchogenic carcinoma

Radiology

The mediastinum in non-small cell lung cancer CT-surgical correlation

AJR

Preoperative staging of lung cancer: accuracy of computed tomography versus mediastinoscopy

Thorax

Original article
Can computed tomography of the chest stage lung cancer?—Yes and no☆