Computed tomography for preoperative assessment of T3 and T4 bronchogenic carcinoma

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Abstract
Between January 1986 and January 1991, 175 patients with suspected T3 orT4 bronchogenic carcinoma underwent computed tomographic (CT) examinationof the chest before thoracotomy. We considered two groups of patients:group 1 includes 98 patients with a paramediastinal mass on standard chestX-ray; invasion of hilar and mediastinal structures was preoperativelyinvestigated with CT and then assessed at thoracotomy. The sensitivity,specificity and accuracy were 72%, 75% and 73%, respectively; positive andnegative predictive values were 71% and 76%. In group 2 77 patients had aperipheral tumor suspected of invading the parietal pleura and the softtissues of the chest wall (patients with evident rib or vertebral invasionwere not included). Sensitivity, specificity and accuracy of CT were 52%,86% and 71%, respectively; positive and negative predictive values were 74%and 70%. We conclude that CT with injection of contrast material isindispensable when direct lung cancer infiltration must be ruled out; itsaccuracy is however not sufficient to be relied upon in all patients.

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