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The Annals of Thoracic Surgery, Vol 51, 182-188, Copyright © 1991 by The Society of Thoracic Surgeons
GB Ratto, G Piacenza, C Frola, F Musante, I Serrano, R Giua, M Salio, P Jacovoni and S Rovida
The aim of this prospective study was to evaluate: (1) the role of computed
tomographic scanning in predicting chest wall invasion by peripheral lung
cancer and (2) the results of operation according to the depth of chest
wall involvement and other potential indicators of long-term survival. One
hundred twelve patients with non-small cell lung cancer adjacent to the
pleural surface who underwent computed tomographic scanning and subsequent
thoracotomy were entered into this study. Tumor invasion was confined to
the visceral pleura in 53 patients, to the parietal pleura in 18 patients,
and to intercostal muscles in 25 patients; invasion extended beyond this
layer in 16 patients. The computed tomographic criteria for chest wall
invasion were (1) obliteration of the extrapleural fat plane, (2) the
length of the tumor-pleura contact, (3) the ratio between the tumor-pleura
contact and the tumor diameter, (4) the angle of the tumor with the pleura,
(5) a mass involving the chest wall, and (6) rib destruction. The computed
tomographic criteria 1 and 3 were significantly related to pathologic
findings. Sensitivity was 85% for criterion 1 and 83% for criterion 3,
specificity being 87% and 80%, respectively. Long-term survival of patients
with T3 disease critically depended on the lymph node state and
completeness of resection. The adenocarcinoma cell type and the T4 category
were unfavorable prognostic factors. The depth of chest wall invasion did
not affect survival, except for extensive rib and soft tissue infiltration.
En bloc resection yielded better results than discontinuous resection.
ARTICLES
Chest wall involvement by lung cancer: computed tomographic detection and results of operation
Institute of Clinica Chirurgica, University of Genoa, Italy.
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