Advertisement

Improving specificity of computed tomography in diagnosis of malignant mediastinal lymph nodes

  • David S. Feigin
    Correspondence
    Address reprint request to: David S. Feigin, MD, Department of Radiology (V-114), University of California, San Diego, La Jolla, California 92093.
    Affiliations
    From the Departments of Radiology, Pathology, and Surgery, Veterans Administration Medical Center, La Jolla; and the University of California, San Diego Medical Center, San Diego, California, USA
    Search for articles by this author
  • Paul J. Friedman
    Affiliations
    From the Departments of Radiology, Pathology, and Surgery, Veterans Administration Medical Center, La Jolla; and the University of California, San Diego Medical Center, San Diego, California, USA
    Search for articles by this author
  • Steven E. Liston
    Affiliations
    From the Departments of Radiology, Pathology, and Surgery, Veterans Administration Medical Center, La Jolla; and the University of California, San Diego Medical Center, San Diego, California, USA
    Search for articles by this author
  • Parviz Haghighi
    Affiliations
    From the Departments of Radiology, Pathology, and Surgery, Veterans Administration Medical Center, La Jolla; and the University of California, San Diego Medical Center, San Diego, California, USA
    Search for articles by this author
  • Richard M. Peters
    Affiliations
    From the Departments of Radiology, Pathology, and Surgery, Veterans Administration Medical Center, La Jolla; and the University of California, San Diego Medical Center, San Diego, California, USA
    Search for articles by this author
  • Jonathan G. Hill
    Affiliations
    From the Departments of Radiology, Pathology, and Surgery, Veterans Administration Medical Center, La Jolla; and the University of California, San Diego Medical Center, San Diego, California, USA
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Four parameters of lymph node appearance on computed tomography were studied to improve specificity for malignancy in bronchogenic carcinoma: 1) node location, 2) homogeneity, 3) border definition, and 4) delineation by fat. Of 54 carcinoma patients, nodes were pathologically malignant in 21. Computed tomography showed enlarged nodes (over 1 cm) in 20 of these (true-positive rate, 96%), but also in 13 of the 33 patients with pathologically benign lymph nodes (false-positive rate, 39%). A combination of all four computed tomography parameters reduced the false-positive rate from 39 to 21% and decreased the true-positive rate from 96 to 86%. The criterion of border definition alone reduced the false-positive rate from 39 to 6%, but decreased the true-positive rate from 96 to 61%. The most useful computed tomography parameter was delineation, which reduced the false-positive rate to 15% and decreased the true-positive rate only to 86%. The computed tomography appearance of enlarged lymph nodes may be used to improve selection of patients with enlarged nodes for preoperative biopsy.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Baron L.
        • Levitt G.
        • Sagel S.
        • et al.
        Computed tomography in the preoperative evaluation of bronchogenic carcinoma.
        Radiology. 1982; 145: 727-732
        • Ekholm S.
        • Albrechtsson U.
        • Kugelberg J.
        • et al.
        Computed tomography in preoperative staging of bronchogenic carcinoma.
        J Comput Assist Tomogr. 1980; 4: 763-765
        • Faling L.
        • Pugatch R.
        • Jung-Legg Y.
        • et al.
        Computed tomographic scanning of the mediastinum in the staging of bronchogenic carcinoma.
        Am Rev Respir Dis. 1981; 124: 690-695
        • Lewis J.
        • Madrazo B.
        • Gross S.
        • et al.
        The value of radiographic and computed tomography in the staging of lung carcinoma.
        Ann Thorac Surg. 1982; 34: 555-558
        • Muller H.
        • Kaick G.
        • Schaaf J.
        • et al.
        Praoperatives staging des Broncialkarzinoms: keit der Computertomogaphie in Vergleich zur konventionellen Radiologie.
        Fortschr Rontgenstr. 1981; 134: 601-607
        • Osborne D.
        • Korobkin M.
        • Ravin C.
        • et al.
        Comparison of plain radiography, conventional tomography, and computed tomography in detecting intrathoracic lymph node metastases from lung carcinoma.
        Radiology. 1982; 142: 157-161
        • Rea H.
        • Shevland B.
        • House A.
        Accuracy of computed tomographic scanning in assessment of the mediastinum in bronchial carcinoma.
        J Thorac Cardiovasc Surg. 1981; 81: 825-829
        • Sommer B.
        • Bauer W.
        • Rath M.
        • et al.
        Die computertomographische Stadieneinteilung des Bronchial -karzinoms. Auswirkungen auf das diagnostische and therapeutische Vorgenhen.
        Computertomographie. 1981; 1: 193-199
        • Swett H.
        • Nagel J.
        • Sostman H.
        Imaging methods in primary lung carcinoma.
        Clin Chest Med. 1982; 3: 331-351
        • Wouters E.
        • Oer T.
        • VanEngelshoven J.
        • et al.
        Evaluation of the contribution of computed tomography to the staging of nonoat-cell primary bronchogenic carcinoma.
        Fortschr Rontgenstr. 1982; 137: 540-543
        • Richey H.
        • Matthews J.
        • Helsel R.
        • et al.
        Thoracic CT scanning in the staging of bronchogenic carcinoma.
        Chest. 1984; 85: 218-221
        • Libshitz H.
        • McKenna Jr., R.
        • Haynie T.
        • et al.
        Mediastinal evaluation in lung cancer.
        Radiology. 1984; 151: 295-299
        • Friedman P.
        • Feigin D.
        • Liston S.
        • et al.
        Sensitivity of radiography, computed tomography and gallium scanning to metastasis of lung carcinoma.
        Cancer. 1984; 54: 1300-1306
        • American Joint Committee for Cancer Staging and End Results Reporting
        Task Force on Lung. Staging in Lung Cancer.
        1979 (Chicago)
        • Tisi G.
        • Friedman P.
        • Peters R.
        • et al.
        Clinical staging of primary lung cancer. Statement of the American Thoracic Society.
        Am Rev Respir Dis. 1983; 127: 659-664
        • Benfield J.
        • DeCaro L.
        When and how to invade for the diagnosis and staging of primary lung cancer.
        Am J Surg. 1981; 143: 670-674
        • Bone R.
        • Balk R.
        Staging of bronchogenic carcinoma.
        Chest. 1982; 82: 473-480
        • Koh H.
        • Prout M.
        The efficient workup of suspected lung cancer.
        Arch Intern Med. 1982; 142: 966-968
        • Little A.
        • DeMeester T.
        • MacMahon H.
        Thestaging of lung cancer.
        Semin Oncol. 1983; 10: 56-59
        • Smith S.
        • Hooper R.
        • Beechler C.
        • et al.
        Indications for mediastinal lymph node evaluation.
        Chest. 1982; 81: 599-604
        • Moak G.
        • Cockerill E.
        • Farber M.
        • et al.
        Computed tomography vs standard radiology in the evaluation of mediastinal adenopathy.
        Chest. 1982; 82: 69-75
        • Goodwin R.
        • Loyd J.
        • Des Prez R.
        Histoplasmosis in normal hosts.
        Medicine. 1981; 60: 231-265
        • Vanek J.
        • Schwarz J.
        The gamut of histoplasmosis.
        Am J Med. 1971; 50: 89-104
        • Picus D.
        • Balfe D.
        • Koehler R.
        • et al.
        Computed tomography in the staging of esophageal carcinoma.
        Radiology. 1983; 146: 433-438
        • Daffner R.
        • Halber M.
        • Postlehwait R.
        • et al.
        CT of the esophagus. II. Carcinoma.
        AJR. 1981; 133: 1051-1056
        • Acosta J.
        • Manfredi F.
        Selective mediastinoscopy.
        Chest. 1977; 71: 150-154
        • Hashim S.
        • Baue A.
        • Geha A.
        The role of mediastinoscopy and mediastinotomy in lung cancer.
        Clin Chest Med. 1982; 3: 353-359
        • Steiger Z.
        • Chaudhry S.
        • Wilson R.
        The use of anterior mediastinotomy to assess intrathoracic lesions.
        Am Surg. 1981; 47: 251-253
        • Libshitz H.
        CT of mediastinal lymph nodes in lung cancer: Is there a “state of the art”? (letter).
        AJR. 1983; 141: 1081-1086
        • Friedman P.
        • Tisi G.
        Regional lymph node calcification system for staging of lung cancer (letters).
        AJR. 1984; 142: 1084-1086