La T.C. nello staging delle neoplasie polmonari

Pulmonary neoplasms management is moreover receiving a multi specialistic approach, involving not only the surgeon but also the radiologist, the chemotherapist and the radiotherapist. In the aim of best programming a team intervention, a most reliable staging is required, obtained studying patients as accurately as possible. For this purpose, 101 patients admitted to our Department of Surgery from May 1, 1986 and December 31, 1989 underwent the following diagnostic procedures: Chest X Ray and Stratigraphy, expectorate specimen examination, broncoscopy and biopsy (when indicated), brushing and bronchial washing and bronchial aspiration, spirometry and CT Scan. 181 pts were studied. CT Scan detected homolateral mediastinal and Para tracheal nodes involvement in 44 cases, and contralateral nodal involvement in 47 cases. Ct Scan after contrast enhancement administration could define division planes between involved nodes and pulmonary or mediastinal vessels, thus helping to judge the radical possibilities of surgery. In 19 cases when the tumor had a peripheral location, CT Scan was useful in order to evaluate chest wall involvement, if present. We also performed 37 CTguided percutaneous biopsies in those cases when bronchoscopic biopsy was unfeasible, obtainings excellent result (2 false negative, 5 false positive). Furthermore CT Scan was employed to detect liver, adrenal glands or brain metastasis. NMR was used during the last 9 months with excellent results; the number of patients studied with this technique is low to allow a statistical comparison with CT. Routine CT Scan allowed us to reduce the amount of exploratory thoracotomies (6) and to avoid any surgical procedure in 47 patients, eventually treated by chemo or radio therapy