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Original Articles: General Thoracic

Helical Computed Tomography Inaccuracy in the Detection of Pulmonary Metastases: Can It Be Improved?

^a Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, North Carolina
^b School of Medicine, University of North Carolina, Chapel Hill, North Carolina
^c Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
^d Division of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut

Accepted for publication June 25, 2007.

^_* Address correspondence to Dr Parsons, Division of Cardiothoracic Surgery, University of North Carolina, 3040 Burnett-Womack Bldg, CB #7065, Chapel Hill, NC 27599-7065 (Email: alden_parsons{at}yahoo.com).

Background: In thoracic surgery, manual lung palpation for detection of pulmonary metastases during resection is the standard of care, despite improvements in computed tomography (CT) imaging. In our previous study based on chart review alone, the accuracy of helical CT in the detection of pulmonary metastases was surprisingly low, with a sensitivity of 78%. We hypothesized that this may be improved by scan interpretation with adequate clinical history and focused documentation of all pulmonary lesions, and may be influenced by the training of the reader.

Methods: Preoperative CT scans of 53 patients undergoing 60 cases of pulmonary metastasectomy at our center from 1996 to 2004 were retrospectively reviewed by a dedicated chest radiologist and a non–chest radiologist. Nodules detected on preoperative helical CT were compared with pathologically confirmed metastases.

Results: In 27 of 59 (46%) cases read by radiologist 1, and 27 of 58 (47%) cases read by radiologist 2, metastases found by lung palpation were not seen on preoperative CT. Preoperative CT was entirely correct (no missed metastases or false-positive lesions) in only 11 of 59 (19%) of cases read by radiologist 1, and 11 of 58 (19%) of cases read by radiologist 2.

Conclusions: Helical CT misses metastases in 46% to 47% of cases. Accuracy of preoperative CT scanning for detection of pulmonary metastases was not improved with the provision of clinical history to the reader, nor was it influenced by the interpreter’s training. A combined approach to pulmonary metastasectomy including preoperative and postoperative CT as well as manual lung palpation is necessary to render the patient disease-free.

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Invited commentary

Cameron D. Wright
Ann. Thorac. Surg. 2007 84: 1836-1837. [Extract] [Full Text] [PDF]

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				L. Erhunmwunsee and T. A. D'Amico Surgical Management of Pulmonary Metastases Ann. Thorac. Surg., December 1, 2009; 88(6): 2052 - 2060. [Abstract] [Full Text] [PDF]

				C. D. Wright Invited commentary Ann. Thorac. Surg., December 1, 2007; 84(6): 1836 - 1837. [Full Text] [PDF]