Diagnostic imaging in metastatic lung disease

Abstract

Chest radiographs, full lung tomography and computed tomography of the chest provide increasing sensitivity for evaluation of pulmonary metastases. Pulmonary nodules of 5-10 mm diameter are detectable with increasing frequency by use of high kilovoltage chest radiographs. Full lung linear tomography provides an overall accuracy of 72-97% in diagnosis of pulmonary nodules. Chest CT delineates pulmonary nodules as small as 3 mm within 10 mm slice sections. However, as sensitivity increases, specificity diminishes in identifying metastatic nodules. Sensitivity in CT is also reduced by false negative findings due to unequal respiratory cycles. Comparative radiologic-pathologic evaluation of nodule detection proved CT to be the most sensitive screening method for pulmonary metastases. Timing of follow-up studies for pulmonary nodule detection in cancer patients can be determined by tumor growth kinetics; 3-6 month intervals proved to be useful.

Metastases detected at the time of diagnosis of primary pediatric extremity osteosarcoma at diagnosis

“…The improved sensitivity of CT compared with chest radiographs provides us with the opportunity to detect lung metastases at a time when aggressive neoadjuvant chemotherapy coupled with pulmonary extirpation of metastases can improve survival. Nodules as small as 3 mm can routinely be identified by CT. 13 It has been estimated that visibility of a 1 cm pulmonary metastasis of OS indicates that three-fourths of its growth has already occurred and that a 1 cm mass corresponds to approximately 1 gram of tissue.…”

Prevalence of alterations in chest computerized tomography in patients with head and neck cancer

“…The presence of synchronous lung tumors or thoracic metastases in patients with head and neck cancer have prognostic implications and may have major impact on treatment 4,8 . In addition, second primary tumors account for approximately half of deaths in patients with successfully eradicated primary head and neck cancer 9 .…”

“…The presence of these manifestations may affect prognosis and management [1][2][3] . The information arising from imaging analysis is an important component for the initial staging and posttreatment evaluation of patients with squamous cell carcinoma of the head and neck 4 . Additionally, the American Joint Committee on Cancer (AJCC) staging Manual states that any diagnostic information that contributes to the overall accuracy of pretreatment assessment should be considered in planning the treatment of such patients 5 .…”

The Role of Chest Computed Tomography in the Work-up of Patients with Cervical or Endometrial Cancer

“…The presence and pattern of calcification are strong indicators for benignancy [16,20,21,24]. Additionally, stability of the lesions for two years, and small size of the lesions (<2 -3, 5 mm) are other factors suggestive of benign disease [10,16,21,22,24,25]. After critical reviewing the chest CT scan reports, further investigation was recommended in 50% (9/18) of the patients with cervical cancer.…”

“…After critical reviewing the chest CT scan reports, further investigation was recommended in 50% (9/18) of the patients with cervical cancer. Although there are several recommendations according the follow-up of pulmonary lesions detected on chest CT scan, there is no clear consensus [19,25]. Chest CT scan seems to be necessary after a normal chest x-ray, only in patients with a high risk for pulmonary metastasis, and in whom detection of occult metastases would alter the therapy [26].…”