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The Annals of Thoracic Surgery, Vol 38, 215-220, Copyright © 1984 by The Society of Thoracic Surgeons
RH Breyer, N Karstaedt, SA Mills, FR Johnston, RH Choplin, NT Wolfman, AS Hudspeth and AR Cordell
Computed tomography (CT) of the chest (late model) was done preoperatively
in 56 candidates for resection of lung cancer. Precise borders for each
node region were defined by the American Thoracic Society modification of
the classification of the American Joint Committee for Cancer Staging and
were used to "map" nodes seen on CT and nodes removed surgically.
Metastatic involvement of mediastinal nodes was proven by mediastinoscopy
in 11 patients; nodes were removed from multiple regions at thoracotomy in
45 patients. The mediastinum was clearly delineated by CT in 46 patients
with determinate scans and was judged normal in 32 (CT-negative scans) and
abnormal in 14 (CT- positive scans). A node was considered metastatically
involved if it measured greater than 1.5 cm in diameter. Positive nodes
were found at surgical staging in 3 of 32 patients with CT-negative scans
and in all patients with CT-positive scans. Thus, for the 46 patients with
determinate scans, sensitivity was 82%, specificity was 100%, and accuracy
(true positive and true negative) was 93%. The high accuracy of CT in these
patients suggests that mediastinoscopy is not necessary before thoracotomy
in the patient with a CT-negative scan, but that for the patient with a
CT-positive or CT-indeterminate scan, the indications for mediastinoscopy
remain the same.
ARTICLES
Computed tomography for evaluation of mediastinal lymph nodes in lung cancer: correlation with surgical staging
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