March 1987

Thoracic Computed Tomography in the Preoperative Evaluation of Primary Bronchogenic Carcinoma

Author Affiliations

From the Pulmonary Disease Service, Department of Medicine (Drs Matthews and Richey), and the Thoracic Surgery Service, Department of Surgery (Drs Helsel andd Grishkin), Brooke Army Medical Center, Fort Sam Houston, Tex.

Arch Intern Med. 1987;147(3):449-453. doi:10.1001/archinte.1987.00370030053012

• One hundred seventy-four patients with bronchogenic carcinoma underwent computed tomography (CT) as part of their preoperative evaluation. Overall, CT had a sensitivity of 86%, a specificity of 78%, and an accuracy of 81% in identifying mediastinal lymph node metastases. In patientswith a central tumor, the sensitivity was 93%, the specificity 74%, and the accuracy 83%. In patients with a peripheral tumor, the respective percentages were 55%, 82%, and 77%. Only 11 of 66 patients with a peripheral tumor had mediastinal metastases, and five of these patients had a normal CT scan. Conversely, 43 of 64 patients with a central tumor and mediastinal lymph node enlargement on the CT scan had unresectable disease, compared with only one of 44 patients without such enlargement. We conclude that CT is not useful in the evaluation of patients with a peripheral tumor; however, it is useful in determining which patients with a central tumor do not require a surgical staging procedure prior to thoracotomy.

(Arch Intern Med 1987;147:449-453)