Role of High-Resolution Computed tomography in the Evaluation of Pulmonary Metastases: A Tertiary Hospital-Based Study
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 8
Abstract
Background: Pulmonary metastases constitute 20–54% of extrathoracic malignancies occurring all over the world. Twenty percent of metastatic disease is isolated to the lungs. Development of lung metastases indicates disseminated disease in patients with known malignancies and puts them in stage IV of tumor, node, and metastasis staging system. This otherwise implies an adverse prognosis and alters the management plan. The role of high-resolution computed tomography (HRCT) remains very important in the screening, detection, and staging of pulmonary metastases. Imaging guidance is also used in histologic confirmation of metastatic disease. Aim of the study: The aim is to study the role of HRCT in the diagnosis of metastases in the lungs using standard methods of HRCT characteristics and cytology/histopathological reports and to calculate the specificity and sensitivity of HRCT in the diagnosis. Materials and Methods: A total of 46 patients with nodular opacities on plain X-Rays of the chest posteroanterior view, attending the department of radiology, were included in the present study. Among them, 39 patients (Group A) were diagnosed previously and under treatment for primary malignant diseases in the same hospital. The other 7 patients (Group B) were not having any primary malignant disease. They were subjected to HRCT chest to include the apices through the lung bases with an average of 18–20 slices per chest at 2 mm intervals. All the HRCTs were reported by a single radiologist. All the patients were either subjected to image-guided or ultrasound-guided fine-needle aspiration cytology or thoracotomy and biopsy. The HRCT characteristics of the margins of the nodules were classified into four types: (1) Well-defined and smooth margin, (2) well-defined and irregular margin, (3) poorly defined and smooth margin, and (4) poorly defined and irregular margin. The HRCT contrast characteristics were classified as solid, mixed, and ground glass types depending on the contrast enhancement of the lesions. Observations and Results: Of 46 patients, Group A had 27 males and 12 females with a male-to-female ratio of 1:2.25. The mean age was 53.35 ± 6.70 years. Group B had 5 males and 2 females with a male-to-female ratio of 1:2.5. The mean age was 59.20 ± 3.85 years. All the patients were smokers. Group “A,” 25/39 (64.10%), patients had a history of intake of alcohol. In Group B, 4/7 (57.14%) patients had a history of intake of alcohol. In Group A, 10/39 (25.64%) were working as industrial workers (alkali industry and carbide industry), 11/39 (28.20%) were agricultural laborers, and the remaining 7/39 (17.94%) were office goers. In Group B, 2/7 (28. 57%) were working as industrial workers (alkali industry and carbide industry), 3/7 (42.85%) were agricultural laborers, and the remaining 2/7 (28.57%) were office goers. There was no statistical significance between the two groups in regard to demographic information, with P = 0.341 (P < 0.05). The specificity of HRCT in the diagnosis of pulmonary metastases was 80% and the sensitivity was 90.47%. Conclusions: HRCT of the chest plays a vital role in the diagnosis of pulmonary metastases either primarily or secondarily. HRCT remains the preferred imaging modality for pulmonary metastases. The technique has some limitations in the detection of pulmonary metastases, especially for nodules <5–6 mm. The specificity of HRCT in the diagnosis of pulmonary metastases was 80% and the sensitivity was 90.47% in the present study.
Authors and Affiliations
M. Vijay Kumar, K. Ravindranath Reddy
Keywords
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