Mediastinal infiltration of lung carcinoma (T4N0-1): the positive predictive value of computed tomography.

The value of computed tomography (CT) in predicting direct mediastinal infiltration of stage T4N0-1 lung carcinoma was evaluated prospectively in 11 patients with surgical and histological proof. Furthermore, its role in twelve non-operated patients was assessed retrospectively. The radiologic signs detected independently by two radiologists correlated in 90%. Mediastinal infiltration was verified in 7 of 11 patients (63%). Only in 3 out of the 12 patients treated non-surgically was CT the only criterium for inoperability. In all other patients additional findings, such as scintigraphy, radiologic or bioptic proof of distant metastases, supported inoperability. The limited specificity of CT (63%) demands aggressive staging procedures before any patient is excluded from surgery, the only potentially curative treatment.