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Ultrasound vs CT in Detecting Chest Wall Invasion by Tumor^*

A Prospective Study

^* From the Baylor College of Medicine (Drs. Bandi and Lunn), Houston, TX; Beth Israel Deaconess Medical Center (Dr. Ernst), Boston, MA; Thoraxklinik (Drs. Eberhardt, Hoffmann, and Herth), University of Heidelberg, Heidelberg, Germany.

Correspondence to: William Lunn, MD, FCCP, Director, Interventional Pulmonary, Baylor College of Medicine, 1709 Dryden Rd, Suite 950, Houston, TX 77030; e-mail: wlunn{at}bcm.tmc.edu

Abstract

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%).

Key Words: CT scan • lung cancer • staging • surgery • ultrasound

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