Lung Nodules in Cancer Patients: Chest CT Scan Misses Up to 66% of Malignant Nodules

Objectives: Chest CT scan is routinely performed to detect lung nodules in patients with pulmonary metastatic cancer. It is necessary to evaluate the patient's operability and to clarify a curative intent. We performed a statistical analysis addressing the concordance of preoperative detection of lung nodules by chest CT scan and intraoperative findings.

Methods: The literature research in Medline and the Cochrane Database of Systematic reviews was structured using the keywords “pulmonary metastasis,” “lung metastasis,” “lung resection,” “pulmonary resection,” “manual palpation,” “manual lung palpation,” “lung palpation,” “occult metastasis,” “additional metastasis,” “overall survival,” “DFI,” “recurrence,” “recurrence rates.” We defined the number of preoperative and intraoperative metastases, perioperative data, postoperative morbidity and postoperative mortality as relevant end points. In absence of any randomized-controlled trial, we performed a qualitative statistical analysis.

Results: Qualitative statistical analysis includes eighteen studies reporting on 1,472 patients. Patients with pulmonary metastases from different primary cancer underwent lung resection between 1990 and 2014. The interval from chest CT scan to manual palpation during operation varied from 8 to 14.9 days. Slice thickness ranged between 1 and 10 mm. Sensitivity of helical chest CT scan was 34% in sarcoma patients in comparison with 60 to 97% in patients with epithelial tumors in detection of pulmonary metastases. Hence, CT scan misses 66% of lung metastases in sarcoma patients. Manual palpation detected all suspected pulmonary nodules, but it also led to a resection of benign nodules in up to 48.5%. Helical chest CT scans led to false-positive diagnosis of malignant lung nodules in 33% of lesions. The risk of non-imaged nodules depends on the number or the size of pulmonary nodules and the histopathology of primary cancer, favoring epithelial tumors.

Conclusion: The current evidence underlines the relevance of manual palpation during pulmonary metastasectomy. Especially in case of sarcoma patients, chest CT scan fails to detect all suspected nodules. Unfortunately, manual palpation resulted in over-diagnosis of every third lung lesion. The surgeon's experience and the use of parenchyma-sparing resection are the most important factors to prevent the patient from the loss of potentially healthy lung parenchyma, but they also allow a curative approach.

 

Scroll to top

Die Autoren geben an, dass kein Interessenkonflikt besteht.