Computed tomography in staging for lung cancer

Abstract

Computed tomography (CT) provides the most detailed imaging information, hence it is generally used as a routine imaging procedure in the tumour, node, metastasis (TNM)-staging of patients with lung cancer. However, despite the continuously ongoing process of improvement in CT scanning in which today9s CT scanners combine fast acquisition, fast data reconstruction and high detail, the technique has important limitations.CT can, in some cases, very accurately show tumour extent within, and predict spread beyond the lung. However, the question of whether the tumour has invaded the chest wall or the mediastinum and, if so, whether it is still potentially surgically curable often remains unanswered. In addition, the only sign for predicting lymph node involvement using CT is enlargement. Many studies have shown that this sign is not very reliable. CT is also, with success, being used to evaluate distant metastases although other techniques such as ultrasound and magnetic resonance imaging can have similar or higher accuracies.Despite these well-known limitations, computed tomography will most likely stay the routine imaging procedure for determining resectability and for assessing intra-and extrathoracic spread of lung cancer. The improvement in technology will probably result a better T-staging. The role of computed tomography in nodal staging remains important. It offers the surgeon a road map of the lymph nodes and guides towards the nodes that need biopsy. Combining computed tomography with positron emission tomography, when it becomes more widely available, will add functional images to the detail of computed tomography and will not only improve nodal staging but will probably also allow a better evaluation of distant metastasis and reduce the number of unnecessary interventional procedures.

Role of multidetector computed tomography in evaluation of suspected bronchogenic carcinoma

“…CT provides precise characterization of the size, contour, extent and tissue composition of the suspicious lesion. 6 Staging lung cancer is, of course, a multidisciplinary process, which also utilizes other procedures such as bronchoscopy and biopsy. The diagnostic yield of bronchial biopsy specimens varies from 70 to 90 percent depending on the site and type of tumour.…”

Usefulness of thin‐section single‐shot turbo spin echo with half‐fourier acquisition in evaluation of local invasion of lung cancer

“…In this study we acquired relatively high values for sensitivity, specificity, and accuracy with thin-section SS-TSE-HF images only, and the results were better than those with CT or conventional MRI (dynamic MRI, THRIVE, and conventional axial SS-TSE-HF) and were also comparable with the combination of static and dynamic MR images on prior studies (6,10,(21)(22)(23). We obtained relatively high sensitivity for detecting local invasion of lung cancer for CT, thin-section SS-TSE-HF, and conventional MRI.…”

“…Magnetic resonance imaging (MRI) can be superior to CT scanning in delineating direct tumor invasion of contact structures with higher tissue contrast (5) and previous reports have shown that the use of contrast enhancement might improve the accuracy of MRI for lung cancer invasion (6,7). Recently, several studies have reported that dynamic MRI such as electrocardiogram (ECG)-gated cardiac cine MRI or respiratory dynamic MRI can improve the prediction accuracy of adjacent mediastinal vascular structures or chest wall invasion of lung cancer (8)(9)(10)(11).…”

Transthoracic ultrasound-guided biopsy in the hands of chest physicians – a stepwise approach

“…First, the cause of the lesion must be determined, and second, in the case of malignancy, it is crucial to determine the correct stage. The advanced computed tomography (CT) technique has had a major influence on the detection of suspected malignant lung nodules [1]. Both smaller and increasing numbers of nodules can now be detected because of improvement in scan resolution [2,3] and screening for lung cancer with CT is gaining ground.…”