Clinical evaluation of computed tomography for detection of pleural and chest wall invasion (P factor) in primary lung cancer

The evaluation of computed tomography (CT) used in detection of the pleural and chest wall invasion was made in fifty-six cases of primary lung canser adjacent to the chest wall. CT findings were investigated about pleural indentation, pleural thickening, extrapleural fat line between tumor and chest wall, rib destruction and chest wall mass. These CT findings were classified in four groups according to P factor and compared with surgical and pathological finding. This comparison showed that overall accuracy in CT diagnosis was 66 %. Evaluation of no pleural invasion (P0) and chest wall invasion (P3) was accurate and specific in CT findings. But sensitivity was relatively low. CT could not demonstrate chest wall invasion in five of twelve patients. There is no defference between squamous cell carcinoma and adenocarcinoma. The tumor masses contiguous to the intercostal muscle were tend to be misdiagnosed on CT, but 85 % of the tumor masses contiguous to the rib was correctly diagnosed. From these results, it was considered that CT was useful for the preoperative diagnosis of pleural and chest wall invasion of lung cancer. (author)