Elsevier

The Annals of Thoracic Surgery

Volume 82, Issue 3, September 2006, Pages 1009-1015
The Annals of Thoracic Surgery

Original article
General thoracic
Accuracy of Surveillance Computed Tomography in Detecting Recurrent or New Primary Lung Cancer in Patients With Completely Resected Lung Cancer

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.
https://doi.org/10.1016/j.athoracsur.2006.03.062Get rights and content

Background

To determine the eventual outcome of abnormalities detected on surveillance computed tomography (CT) in patients with previously resected nonsmall-cell lung cancer (NSCLC), and to assess the accuracy of CT when used by the thoracic surgeon, and to determine the characteristics of abnormalities on CT that correlate with the development of recurrent NSCLC.

Methods

A cohort of patients who had abnormal postoperative CT scans of the chest and upper abdomen in 2002 were followed up into 2005. Abnormalities consisted of pulmonary nodules, pleural effusions, or adenopathy. Data collected included recurrence patterns, the availability of previous scans for comparison, the interval between initial resection and the abnormal CT, nodule size, growth, and multiplicity, as well as progression of pleural effusions or adenopathy.

Results

In all, 105 scans in 92 patients were read as abnormal in 2002 by the radiologist. After further investigation or follow-up, or both, for a mean of 3.2 years, 78% of patients who had recurrent NSCLC had their site of first recurrence inside the chest. The negative predictive value of CT when used by the thoracic surgeon was 99%; however, the positive predictive value was only 53%. Abnormalities that correlated with the diagnosis of recurrent cancer included pulmonary nodules that either grew or were larger than 1 cm and pleural effusions that developed after the first postoperative year.

Conclusions

Intrathoracic recurrent NSCLC was rarely missed by the surgeon utilizing surveillance CT, but a significant number of negative investigations were generated by its use. Characteristics of abnormal surveillance CT findings exist that correlate with the presence of malignancy.

Section snippets

Patient Cohort and Study Design

A previously identified cohort of 92 patients with previously resected NSCLC who underwent 105 surveillance CT scans of the chest and upper abdomen in 2002 were included in this study. These 92 patients are part of a larger cohort of 213 patients who presented for follow-up in 2002 after previous complete resection for NSCLC [1]. Of these original 213 patients, 140 underwent surveillance CT scanning in 2002, with a total of 168 total scans being performed. The present group of 92 patients

Results

In 2002, 105 surveillance scans in 92 patients were read as abnormal by the radiologist with regard to pulmonary nodules, pleural fluid, and adenopathy. The stage distribution of the initially resected NSCLC in this cohort was as follows: IA, 48; IB, 23; IIA, 2; IIB, 6; IIIA, 6; IIIB, 3; and IV, 4. All 92 patients underwent an anatomic resection of their initial primary tumor except for 5 patients who had limited resections (4 segmentectomies and 1 multiple wedge resections). Anatomic

Comment

The follow-up of patients with completely resected NSCLC remains controversial. Surveillance CT of the chest is commonly performed after initial curative resection for this disease, despite lack of supporting data. A previous report from our group described a cohort of 140 patients who underwent surveillance CT of the chest and upper abdomen in 2002, along with the findings observed on these scans [1]. The goal of the present study is to document the recurrence patterns in the patients with

References (7)

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