Sensitivity of chest radiography, computed tomography, and gallium scanning to metastasis of lung carcinoma

Abstract

To determine the efficacy of radiologic techniques in preoperative staging of the mediastinum for lung carcinoma, the authors studied 45 patients with chest films supplemented with oblique views, esophagrams, gallium scans, and computed tomograms (CT). They interpreted the studies and correlated surgical findings using a modified classification of lymph node regions. The mediastinum was positive on chest films in 14 of the 21 cases with pathologically proved mediastinal metastases (33% false‐negative). Gallium scans in cases with a positive primary were positive in 12 of 15 cases with mediastinal or hilar metastases (20% false‐negative). Computed tomography showed nodes over 1 or 1.5 cm in size in or adjacent to the biopsy‐positive node region in 18 of 19 patients (5% false‐negative), extranodal mediastinal involvement, and 9 of 10 proven hilar metastases. Computed tomography is a sensitive screening technique in patients who would otherwise require an invasive staging procedure, but is not highly specific (false‐positive rate 38%).

Comparison of examination of thoracic radiographs and thoracic computed tomography in dogs with appendicular osteosarcoma

“…There are many explanations for the fact that more nodules and nodules of smaller sizes are detected using CT compared with thoracic radiographs. CT provides high‐resolution cross‐sectional images with minimal anatomic superimposition and superior contrast resolution 15,27,28 . In addition, standardized breath‐hold techniques appear to result in better and more consistent lung inflation that can improve nodule detection, particularly near aerated lung to soft‐tissue interfaces, such as the thoracic wall and diaphragmatic surfaces 17 .…”

Comparison of Thoracic Radiographs and Single Breath-Hold Helical CT for Detection of Pulmonary Nodules in Dogs with Metastatic Neoplasia

“…Helical CT has previously been shown to be more sensitive than thoracic radiography for detection of pulmonary nodules in people. [1][2][3][4][5][6][7][8][9] Specifically, 1 study using helical CT to detect stage I pulmonary masses found that 73% of the affected patients had unremarkable thoracic radiographs, 9 and a 2nd study revealed that more nodules were detected using CT as compared with thoracic radiographs in 66% of the patients. 2 Even considering these findings in man, the degree to which helical CT surpassed thoracic radiographs for nodule detection and for the size threshold of detection in the current study was surprising.…”

“…However, the specificity of CT for detecting pulmonary metastatic nodules can be lower than that of thoracic radiography because more small, nonneoplastic, and clinically insignificant nodules are likely to be identified. [8][9][10][11] Systematic studies comparing thoracic radiographic and CT techniques in veterinary patients with suspected pulmonary metastatic disease have, to our knowledge, not been reported. A study that directly compared the 2 techniques in a canine model of human disease found that CT was more sensitive than thoracic radiography for detecting pulmonary infarcts.…”

Prospective evaluation of computed tomography and mediastinoscopy in mediastinal lymph node staging

“…Many studies have evaluated the global accuracy of CT in the staging of mediastinal nodal status in lung cancer [14][15][16][17][18][19][20][21][22][23]. Some of these studies have reported a high sensitivity, ranging 88-94% [14,15], values that are equivalent to the sensitivity obtained by mediastinoscopy [6,24,25].…”