Mediastinal Infiltration of Lung Carcinoma (T4N0-1): the Positive Predictive Value of Computed Tomography

Abstract

The value of computed tomography (CT) in predicting direct mediastinal infiltration of stage T4N0-1 lung carcinoma was evaluated prospectively in 11 patients with surgical and histological proof. Furthermore, its role in twelve non-operated patients was assessed retrospectively. The radiologic signs detected independently by two radiologists correlated in 90%. Mediastinal infiltration was verified in 7 of 11 patients (63%). Only in 3 out of the 12 patients treated non-surgically was CT the only criterium for inoperability. In all other patients additional findings, such as scintigraphy, radiologic or bioptic proof of distant metastases, supported inoperability. The limited specificity of CT (63%) demands aggressive staging procedures before any patient is excluded from surgery, the only potentially curative treatment.

Flexible Videopericardioscopy in cT4 Nonsmall-Cell Lung Cancer With Radiologic Evidence of Proximal Vascular Invasion

“…Nonetheless, multislice CT scan showed a 60.0% positive predictive value in assessing tumor spread to proximal vessels. This result is similar to that reported in previous studies employing conventional CT [7][8][9][10][11], while it is somewhat worst than that reported in one study by thin-section electron-beam CT [26] in which accuracy, sensitivity, and specificity in evaluating invasion of the pulmonary artery were 75%, 77.8%, and 71.4%, respectively. It is worth noting that, in this study, if one considers left-sided FVP only, negative predictive value was 100%, which suggests a high accuracy in detecting resectable lesions in these patients.…”

Staging of bronchogenic carcinoma

“…7). Using these criteria, sensitivity has been found to range from 53 to 84% and specificity from 57 to 94% [10,[32][33][34][35][36]. Of importance is the fact that the positive predictive value is in the 64 to 84% [32,36] range, and therefore one must be very careful in calling the patient inoperable by CT criteria alone.…”

Imaging the Advancing Frontier of Lung Cancer Operability

“…Numerous studies have suggested that unless invasion is obvious or the tumor obviously is not invasive, no criteria are reliable enough to be clinically useful. 38,[43][44][45][46][47] Specifically in the consideration of vascular invasion, most investigators concur that MRI is more sensitive than CT. 48 Suspected vascular invasion may also be approached by angiography.…”