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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 413-420, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JR Izbicki, O Thetter, O Karg, T Kreusser, B Passlick, A Trupka, K Haussinger, W Woeckel, RW Kenn and DK Wilker
There is an increasing demand for accurate preoperative and intraoperative
staging of bronchial carcinoma with respect to neoadjuvant therapy
protocols and parenchyma-sparing operations. This study prospectively
evaluated accuracy of computed tomographic scan and surgical assessment for
staging of bronchial carcinoma in 108 consecutive patients. The stage of
the primary tumor (T stage) was correctly determined in 85% of the
patients, and surgical evaluation correctly determined the T stage in 92%.
Invasion of major mediastinal structures posed a major problem for computed
tomographic scan. On a node-by-node basis, computed tomographic scan
predicted involvement of lymph nodes in 81% (sensitivity 29%, specificity
93%, positive predictive value 49%, negative predictive value 85%). The
surgeon correctly determined the lymph node status in 69% of lymph nodes
(sensitivity 90%, specificity 63%, positive predictive value 39%, negative
predictive value 96%). On a patient-by-patient basis, computed tomographic
scan correctly predicted the nodal status in 58% of patients. Accuracy of
computed tomographic scan and surgical assessment in determination of the
lymph node status strongly depended on tumor type and lymph node region
(hilar or mediastinal region) studied. This was partly due to the fact that
adenocarcinomas exhibited a high proportion of tumor-positive normal-sized
lymph nodes, whereas squamous cell carcinomas showed a high proportion of
enlarged tumor-free lymph nodes. In conclusion, computed tomographic scan
and surgical assessment are sufficiently accurate for determination of the
tumor stage but are insufficient in determining the nodal status.
ARTICLES
Accuracy of computed tomographic scan and surgical assessment for staging of bronchial carcinoma. A prospective study
Department of Surgery, University of Munich, Germany.
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