Abstract
Purpose
To assess the feasibility of low-dose CT (LDCT) in the detection of pulmonary metastases
in patients with primary gynecologic malignancies and also to compare the performance
of chest digital radiography (DR) and LDCT for their delectability of pulmonary metastases,
with use of standard-dose CT (SDCT) as the reference standard.
Materials and methods
Thirty female patients with primary gynecologic malignancies (age range, 20–76 years;
mean age, 50 years) underwent DR, noncontrast LDCT and contrast-enhanced SDCT, which
were performed within an interval of 2 weeks. We used lung nodule, mediastinal lymphadenopathy
(>10 mm in the short axis) and pleural changes (including effusion, irregular thickening,
or nodularity) as the cardinal imaging findings of lung metastases. A five-point scoring
system was designed to indicate the probability of lung metastasis from primary gynecologic
malignancies. The five-point scores of DR, LDCT, and SDCT were analyzed by receiver
operating characteristic (ROC) curve.
Results
SDCT probability scores of +2 and −2 were set to indicate true positive and true negative
for pulmonary nodule, mediastinal lymphadenopathy, and pleural effusion, respectively.
All the areas under the ROC curve of LDCT appeared to be larger than those of DR{pulmonary
nodule: 0.96 [95% confidence interval (CI): 0.92–1.01] vs. 0.74 [95% CI: 0.57–0.91],
0.82 [95% CI: 0.70–0.95] vs. 0.61 [95% CI: 0.50–0.77]; mediastinal lymphadenopathy:
0.98 [95% CI: 0.93–1.03] vs. 0.90 [95% CI: 0.79–1.01], 0.94 [95% CI: 0.82–1.06] vs.
0.66 [95% CI: 0.44–0.88]; and pleural effusion: 0.98 [95% CI: 0.93–1.03] vs. 0.56
[95% CI: 0.29–0.82], 0.90 [95% CI: 0.74–1.05] vs. 0.46 [95% CI: 0.23–0.68]}.
Conclusion
The performance of LDCT were comparable to those of SDCT and superior to those of
DR for detection of pulmonary nodule, mediastinal lymphadenopathy, and pleural effusion.
By using LDCT, there was no need of intravenous contrast injection and less radiation
exposure. We propose a protocol including standard-dose abdominal CT and low-dose
chest CT for the initial and follow-up stagings of primary gynecologic malignancy.
The use of chest DR is unnecessary.
Keywords
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Article info
Publication history
Published online: September 13, 2004
Received:
July 25,
2003
Identification
Copyright
© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
