Computed tomography vs standard radiology in the evaluation of mediastinal adenopathy.

The value of computed tomography (CT) compared with standard radiology (SR) in the evaluation of mediastinal nodes has not been clearly defined. We compared SR and CT findings with the surgical-pathologic observations in a prospective study of 51 mediastinal nodes in 59 patients, 41 with bronchogenic carcinoma and 18 with benign lung lesions. CT was characterized by a low overall accuracy (true positivity plus true negativity = 60 percent) due to the false positivity (6 percent) and, to a much greater extent, the false negativity (51 percent). The pattern was the same in the malignant and in the benign group. In all instances CT findings were statistically the same as SR findings. We conclude that mediastinal CT provides no advantage over SR. Thus, SR alone is sufficient to select the surgical procedure of choice for evaluating mediastinal nodes, and no radiologic modality should replace surgical exploration in staging mediastinal nodal pathology.

T1N0M0 lung cancer: evaluation with CT.

Although computed tomography (CT) is widely used in the evaluation of lung cancer, its use in the evaluation of clinical stage T1N0M0 lung cancer remains controversial. To evaluate the utility of CT, the authors studied 35 patients with clinical stage T1N0M0 lung cancer who underwent CT. Thoracotomy, mediastinoscopy, or fine-needle aspiration biopsy were performed in 26 of the patients. Metastases were proved in six of these patients, with CT demonstrating adenopathy in four of the six and a contralateral mass in one. Chest wall invasion was not demonstrated with CT in one patient. The overall prevalence of metastatic lesions in this group of 26 patients was 23.1%, with 15.4% of the 26 having unresectable lesions. CT demonstrated all metastatic lesions that precluded curative surgery. The results suggest that CT is clinically useful in the evaluation of clinical stage T1N0M0 lung cancer.