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85 dose reduction could be expected without degrading the image quality. FCR imaging proved superior to the con- ventional radiography, except for a long- er processing time, and more efficacious in the peripheral area. CT Evaluation of Recurrent Tumor At The Parietal Pleura In Postsurgical Patient for Lung Cancer. Murao, T., Kono, M., Hara, M., Sunzuki, H. Ilida, A., Okumura, E., Mimura, M., Niwa, K., Matsuo, M. Department of Radiology, Nagoya City University Medical School, Nagoya 467, Japan. The utility of CT for detecting tumor recurrence in the operated patient for lung cancer had been reported by several authors. Because of the postoperative ap- pearances of intrathoracic structures, such as a presence of dead space and thick- ening of the parietal pleura is often dif- ficult. In this study, CT findings of the recurrent cancer at the parietal pleura was discussed. Twenty one patients (8 postpneumonec- tomy and 13 post-lobectomy patients) were examined by CT from April to December in 1984. At the time of evaluation, 4 out of 21 patients developed recurrence at the parietal pleura, and 17 patients had no clinical evidence of recurrence, however, 4 of the 17 patients had mediastinal lymph nodal metastasis. In 2 of the 4 recurrence cases, rib de- struction was recognized. In 3 of the 4, mass density extending into the chest wall and interruption of fat density out- side the thickened parietal pleura was ob- served in 4 of the 17 non-recurrence cases and also in 3 of the 4 recurrence cases. Rib destruction, mass density extend- ing into the chest wall, and interruption of fat density outside the thickened pari- etal pleura were considered to be manife- stations of recurrent tumor at the parie- tal pleura. Localized thickening of the parietal pleura was considered to be sug- gestive finding of tumor recurrence. Minimal Requirement in Preoperative Image Study for Staging of Lung Cancer Patients Without Extrathoracic Symptoms; With Empha- sis on the Role of CT Scan. Osada, H., Nakajima, Y., Taira, Y., Okote, K., Noguchi, T. St. Marianna Medical Col~ lege, Kawasaki, Japan. It remains controversial how far the preopeative work up is required for stag- ing. We have tested a hypothesis that patients without extrathoracic symtoms need only be studied by thoracic CT, omit- ting studies for distant metastases. We have reviewed 67 consecutive patients of lung cancer without extrathoracic symptoms. Most were studied by brain CT, liver/adrenal CT and bone scan as for distant metastasis(M- factor), and thoracic CT as for mediastinal nodes (N-factor). All underwent thoracotomy. As of M-factor each scan/CT was regarded omittable when either preop study was negative, or the patient reamined clinically negative for more than 12 months postop even with absent preop study. Brain/liver/adrenal CT were thus regarded retrospectively omittable, whereas bone scan could not be totally omittable, though quite unreliable, because it yielded equivocal spots in 22/63 preop study, where only three proved true positive postop. As of N-factor there were one case of unne- cessary thoracotomy due to underscoring. Accu- racy in CT reading was extracted by reviewing 37 cases having full pathological data regard- ing mediastinal nodes, and was all over 70%, whereas subcarinal, peritracheal and periaor- tic subgroups yielded accuracy of 78, 82 and 88% respectively. The hypothesis seems valid but for bone scan. Role of Mediastinoscopy and CT-scanning For Assessment of Lung Cancer Resectability. Rosado-Lopez, L., Jamieson, W.R.E., Robinson, C.L.N., Munro, A.I., Hayden, R.I., Burr, L.H. Vancouver General Hospital, Vancouver, Canada. Mediastinoscopy is generally considered the most accurate method to assess lung cancer re- sectability. The role of both computerized to- mography (4th generation scanner) and media- stinoscopy was considered during a six month period in 52 patients (male, 35; female, 17) (mean age 61.4 years, age range 30-84 years). Mediastinoscopy was performed in all 52 patients, positive 17 (32.7%) and negative 35 (67.3%). At thoracotomy 26 of 35 were true negative and 9 were false negative. Of the 17 patients with positive mediastinoscopy, 14(82.3%) had an ab- normal mediastinum and 3 (17.7%) a negative me diastinum on routine chest radiography. Thirty- one patients had CT scanning, of the patients with positive mediastinoscopy 9 were CT posi- tive and none were CT negative; of the negati- ve mediastinoscopy, 8 were CT positive and 14 were CT negative. Of the 8 CT positive, 6 were true CT positive and 2 false CT positive. Chest radiograph and CT scan were compared, positive without CT, 8; negative without CT, 13; posi- tive with CT, 9; and negative with CT, 22. Of the 9 false negative mediastinoscopy cases, 6 were left upper lobe and two right upper lobe and one positive retrotracheal node on needle biopsy (three false negative without CT scan and six false negative with CT scan). CT S~nnlq MedJast~ Sensitivity 10096 65% Specificity 87% 10096 Accuracy 93% 83% Predictive Valve - Positive 88% 100% PredleUve Value - Negative 100% 74%

CT Evaluation of recurrent tumor at the parietal pleura in postsurgical patient for lung cancer

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Page 1: CT Evaluation of recurrent tumor at the parietal pleura in postsurgical patient for lung cancer

85

dose reduction could be expected without

degrading the image quality. FCR imaging proved superior to the con-

ventional radiography, except for a long- er processing time, and more efficacious in the peripheral area.

CT Evaluation of Recurrent Tumor At The Parietal Pleura In Postsurgical Patient for Lung Cancer. Murao, T., Kono, M., Hara, M., Sunzuki, H. Ilida, A., Okumura, E., Mimura, M., Niwa, K., Matsuo, M. Department of Radiology, Nagoya City University Medical School, Nagoya 467, Japan.

The utility of CT for detecting tumor recurrence in the operated patient for lung cancer had been reported by several authors. Because of the postoperative ap- pearances of intrathoracic structures, such as a presence of dead space and thick- ening of the parietal pleura is often dif- ficult. In this study, CT findings of the recurrent cancer at the parietal pleura

was discussed. Twenty one patients (8 postpneumonec-

tomy and 13 post-lobectomy patients) were examined by CT from April to December in 1984. At the time of evaluation, 4 out of 21 patients developed recurrence at the parietal pleura, and 17 patients had no clinical evidence of recurrence, however, 4 of the 17 patients had mediastinal lymph

nodal metastasis. In 2 of the 4 recurrence cases, rib de-

struction was recognized. In 3 of the 4, mass density extending into the chest wall and interruption of fat density out- side the thickened parietal pleura was ob- served in 4 of the 17 non-recurrence cases and also in 3 of the 4 recurrence cases.

Rib destruction, mass density extend- ing into the chest wall, and interruption of fat density outside the thickened pari- etal pleura were considered to be manife- stations of recurrent tumor at the parie- tal pleura. Localized thickening of the parietal pleura was considered to be sug- gestive finding of tumor recurrence.

Minimal Requirement in Preoperative Image Study for Staging of Lung Cancer Patients Without Extrathoracic Symptoms; With Empha- sis on the Role of CT Scan. Osada, H., Nakajima, Y., Taira, Y., Okote, K., Noguchi, T. St. Marianna Medical Col~

lege, Kawasaki, Japan. It remains controversial how far the

preopeative work up is required for stag- ing. We have tested a hypothesis that patients without extrathoracic symtoms need only be studied by thoracic CT, omit-

ting studies for distant metastases. We have reviewed 67 consecutive patients of

lung cancer without extrathoracic symptoms.

Most were studied by brain CT, liver/adrenal

CT and bone scan as for distant metastasis(M- factor), and thoracic CT as for mediastinal nodes (N-factor). All underwent thoracotomy.

As of M-factor each scan/CT was regarded omittable when either preop study was negative, or the patient reamined clinically negative for more than 12 months postop even with absent preop study. Brain/liver/adrenal CT were thus regarded retrospectively omittable, whereas bone scan could not be totally omittable, though quite unreliable, because it yielded equivocal spots in 22/63 preop study, where only three proved true positive postop.

As of N-factor there were one case of unne- cessary thoracotomy due to underscoring. Accu- racy in CT reading was extracted by reviewing 37 cases having full pathological data regard- ing mediastinal nodes, and was all over 70%, whereas subcarinal, peritracheal and periaor- tic subgroups yielded accuracy of 78, 82 and 88% respectively. The hypothesis seems valid but for bone scan.

Role of Mediastinoscopy and CT-scanning For Assessment of Lung Cancer Resectability. Rosado-Lopez, L., Jamieson, W.R.E., Robinson, C.L.N., Munro, A.I., Hayden, R.I., Burr, L.H. Vancouver General Hospital, Vancouver, Canada.

Mediastinoscopy is generally considered the most accurate method to assess lung cancer re- sectability. The role of both computerized to- mography (4th generation scanner) and media- stinoscopy was considered during a six month period in 52 patients (male, 35; female, 17) (mean age 61.4 years, age range 30-84 years). Mediastinoscopy was performed in all 52 patients, positive 17 (32.7%) and negative 35 (67.3%). At thoracotomy 26 of 35 were true negative and 9 were false negative. Of the 17 patients with positive mediastinoscopy, 14(82.3%) had an ab- normal mediastinum and 3 (17.7%) a negative me diastinum on routine chest radiography. Thirty- one patients had CT scanning, of the patients with positive mediastinoscopy 9 were CT posi- tive and none were CT negative; of the negati- ve mediastinoscopy, 8 were CT positive and 14 were CT negative. Of the 8 CT positive, 6 were true CT positive and 2 false CT positive. Chest radiograph and CT scan were compared, positive without CT, 8; negative without CT, 13; posi- tive with CT, 9; and negative with CT, 22. Of the 9 false negative mediastinoscopy cases, 6 were left upper lobe and two right upper lobe and one positive retrotracheal node on needle biopsy (three false negative without CT scan and six false negative with CT scan).

CT S ~ n n l q M e d J a s t ~ Sensit ivi ty 10096 65% Specif icity 87% 10096 Accuracy 93% 83% Predictive Valve - Positive 88% 100% PredleUve Value - Negat ive 100% 74%