Chest
Volume 133, Issue 4, April 2008, Pages 881-886
Journal home page for Chest

Original Research
Interventional Pulmonology
Ultrasound vs CT in Detecting Chest Wall Invasion by Tumor: A Prospective Study

https://doi.org/10.1378/chest.07-1656Get rights and content

Background

Lung cancer is one of the leading causes of cancer-related deaths worldwide. Accurate staging is important for patient management and clinical research. The recognition of chest wall involvement preoperatively is important for staging and surgical planning. Multiple modalities are available to assess the chest wall involvement preoperatively, including CT scanning, MRI, and ultrasound (US) examination. The purpose of this study was to evaluate the sensitivity and specificity of the US examination in determining the chest wall involvement of lung cancer compared to that of CT scan and surgery.

Methods

A total of 136 patients with clinical suspicion of chest wall involvement were recruited. Ninety patients met the inclusion criteria and underwent CT scanning, transthoracic US, and surgical exploration. A final determination regarding chest wall involvement was made after reviewing the final pathology results and surgical staging.

Results

Chest wall invasion by tumor was noted in 26 patients during surgery and final pathologic examination of the tissue. Of these patients, US correctly identified 23 patients tumor invasion, while CT scanning identified 11 patients with tumor invasion. There were 3 false-positive results and 3 false-negative results with US examination, compared to 15 false-negative results and no false-positive results with CT scanning.

Conclusions: US has better sensitivity (89%) and specificity (95%) in assessing chest wall involvement by a lung tumor compared to CT scan examination (sensitivity, 42%; specificity, 100%).

Section snippets

Materials and Methods

The study was conducted at the Thoraxklinik in Heidelberg, Germany, between January 2003 and November 2005. The study was approved by the institutional review board of the University of Heidelberg and informed consent was obtained from patients.

Patients with a diagnosis of lung cancer and suspected chest wall involvement who were able to provide informed consent were prospectively recruited for the study. Patients with suspicion for Pancoast tumor and mesothelioma were excluded. Patients with

Results

At surgery, chest wall invasion by tumor was found in 26 of 90 patients (the tumor invasion group). Parietal and visceral pleura were not involved in 64 of the 90 patients (the tumor impression group). Tumor invasion data from US examinations, CT scans, and surgery are outlined in Table 3. Of the 90 patients, CT scans identified 11 patients with tumor invasion and 79 patients with tumor impression. US identified 26 patients with tumor invasion and 64 patients with tumor impression. CT scanning

Discussion

Chest wall invasion is not a contraindication for surgery. Long-term survival after resection depends on the completeness of resection and absence of mediastinal and distant metastases.8 Numerous studies have evaluated the role of imaging in the diagnosis of chest wall invasion. However, there is no consensus on the best diagnostic approach. Indeed, the latest American College of Chest Physicians guidelines on the noninvasive staging of non-small cell cancer do not address this particular issue.

Conclusion

US is more sensitive than CT scanning in the evaluation of chest wall invasion and compliments CT scan data. The extension of tumor beyond the parietal pleura into the chest wall can be confidently determined if the mass is seen to breech the pleura, with loss of the movement of the mass with respiration. We hope that more clinicians will start using thoracic US in the near future.

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    Dr. Lunn has taught ultrasound courses that were partially supported by manufacturers of ultrasound equipment including SonoSite and Hitachi. Dr. Ernst has directed and taught ultrasound courses that were partially supported by manufacturers of ultrasound equipment including SonoSite and Hitachi. Dr. Herth has directed and taught ultrasound courses that were partially supported by manufacturers of ultrasound equipment including SonoSite and Hitachi. Drs. Bandi, Eberhardt, Hoffmann have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    All work was performed at Thoraxklinik, University of Heidelberg, Heidelberg, Germany.

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