Chest CT for known or suspected lung cancer.

tinal metastases; pulmonary nodule L ung cancer causes more cancer-related deaths in the United States than any other malignancy. Two facts account for this disturbing observation. The incidence of lung cancer in both men and women has progressively increased in recent years. Treatment of lung cancer remains largely ineffective. The overall 5-year survival rate for patients with lung cancer may be as low as 7 percent to 14 percent. The best survival rates are found in the subgroup of patients with lung cancer with surgically resectable tumors. Clinicians, therefore, are vitally interested in recognizing lung cancer early and determining surgical resectability accurately. Computed tomography (CT) was introduced into clinical practice in the 1970s as an exciting new method for imaging the thorax. Since then, clinicians have come to rely heavily on CT for evaluating potentially malignant chest lesions and the intrathoracic spread of lung cancer. A survey of thoracic surgeons in 1986 revealed that more than one third of these surgeons order CT routinely for all patients with lung cancer and 62 percent more selectively obtain CT scans.1 Despite the frequency at which clinicians obtain CT scans, it is still unclear what role CT plays in the treatment of patients with suspected and known lung cancers. Clinicians are especially concerned with how well CT performs in distinguishing benign from malignant solitary pulmonary nodules (SPN) and in staging the primary tumor (T) and regional node (N) extent of lung cancer (Table 1). In this review, the role CT should play in evaluating SPNs and assessing the T and N stages of lung cancer will be critically evaluated.

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