Preoperative evaluation of the depth of chest wall invasion and the extent of combined resections in lung cancer patients

Non–Small Cell Lung Cancer Invading the Chest Wall

“…Many studies do not include them in their report, 3,7,10,13,14,17 or only report the R0 and R1 resections. 6,11 This raises the question of how to detect whether the parietal pleura and the CW are infiltrated, not only to assess the diagnosis but also to foresee resection incompleteness, in order to prevent its risk by resorting multimodality treatments or definitely precluding surgery.…”

“…20,21 However, limitations and low accuracy of static computed tomography (CT) scan or MRI have been highlighted, 22 and even highresolution CT scan, or ultrasonography (US) may not help answer the question of whether the parietal pleura and CW are infiltrated or not. 17,22,23 Respiratory dynamic (RD) MRI may add much. Demonstrating the independent movement of the CW and lungs during breathing may help rule out parietal pleural invasion; RD-MRI has a sensitivity of 100% and specificity of 82.9% as a result of possible presence of inflammatory dense adhesions.…”

“…Although suggested to be beneficial, adjuvant therapy has not yet significantly demonstrated its efficacy in several other studies. 3,6,8,10,14,17 Such results may simply reflect patient selection, patients with advanced tumors being more likely to be treated by radiation therapy. The issue remains unresolved, but radiation therapy does not seem to prevent local recurrence, which raises the question of reserving its use for highly selected patients or in the case of local recurrence.…”

Primary lung tumors invading the chest wall

“…In fact, CT was accurate in 91% (5) and 50% (6) in diagnosis of T3 tumors, even if such data were obtained with less sophisticated radiological technologies than actual. The use of ultrasonography and especially respiratory dynamic MRI, with the demonstration of the independent CW and lungs movements during breathing, may be useful to rule out a possible invasion of the parietal pleura (7)(8)(9).…”

Predicting pleural invasion using HRCT and 18F-FDG PET/CT in lung adenocarcinoma with pleural contact

“…The diagnostic accuracy of preoperative clinical staging of lung carcinoma has been improved by advances of various imaging modalities such as ultrasonography, computed tomography (CT), magnetic resonance imaging, and fluorine-18-fluorodeoxyglucosepositron emission tomography ( 18 F-FDG PET). Independent predictors of chest wall invasion by lung carcinoma include chest pain and obvious chest wall invasion to the soft tissue or ribs on preoperative chest CT [1]. Furthermore, the diagnostic accuracy of chest wall invasion has been improved by ultrasonography [2], CT [3,4], and magnetic resonance imaging [5], including respiratory dynamic studies.…”