The diagnostic performance of routinely acquired and reported computed tomography imaging in patients presenting with suspected pleural malignancy

Tsim, S., Stobo, D. B., Alexander, L., Kelly, C. and Blyth, K. G. (2017) The diagnostic performance of routinely acquired and reported computed tomography imaging in patients presenting with suspected pleural malignancy. Lung Cancer, 103, pp. 38-43. (doi: 10.1016/j.lungcan.2016.11.010) (PMID:28024694) (PMCID:PMC5226066)

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Abstract

Objectives: Contrast-enhanced computed tomography (CT) provides essential cross-sectional imaging data in patients with suspected pleural malignancy (PM). The performance of CT in routine practice may be lower than in previously reported research. We assessed this relative to ‘real-life’ factors including use of early arterial-phase contrast enhancement (by CT pulmonary angiography (CTPA)) and non-specialist radiology reporting. Materials and methods: Routinely acquired and reported CT scans in patients recruited to the DIAPHRAGM study (a prospective, multi-centre observational study of mesothelioma biomarkers) between January 2014 and April 2016 were retrospectively reviewed. CT reports were classified as malignant if they included specific terms e.g. “suspicious of malignancy”, “stage M1a” and benign if others were used e.g. “indeterminate”, “no cause identified”. All patients followed a standard diagnostic algorithm. The diagnostic performance of CT (overall and based on the above factors) was assessed using 2 × 2 Contingency Tables. Results: 30/345 (9%) eligible patients were excluded (non-contrast (n = 13) or non-contiguous CT (n = 4), incomplete follow-up (n = 13)). 195/315 (62%) patients studied had PM; 90% were cyto-histologically confirmed. 172/315 (55%) presented as an acute admission, of whom 31/172 (18%) had CTPA. Overall, CT sensitivity was 58% (95% CI 51–65%); specificity was 80% (95% CI 72–87%). Sensitivity of CTPA (performed in 31/315 (10%)) was lower (27% (95% CI 9–53%)) than venous-phase CT (61% (95% CI 53–68%) p = 0.0056). Sensitivity of specialist thoracic radiologist reporting was higher (68% (95% CI 55–79%)) than non-specialist reporting (53% (95% CI 44–62%) p = 0.0488). Specificity was not significantly different. Conclusion: The diagnostic performance of CT in routine clinical practice is insufficient to exclude or confirm PM. A benign CT report should not dissuade pleural sampling where the presence of primary or secondary pleural malignancy would alter management. Sensitivity is lower with non-thoracic radiology reporting and particularly low using CTPA.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Alexander, Mrs Laura and Kelly, Mrs Caroline and Blyth, Dr Kevin and Tsim, Dr Selina
Authors: Tsim, S., Stobo, D. B., Alexander, L., Kelly, C., and Blyth, K. G.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
Journal Name:Lung Cancer
Publisher:Elsevier
ISSN:0169-5002
ISSN (Online):1872-8332
Published Online:18 November 2016
Copyright Holders:Copyright © 2016 The Authors
First Published:First published in Lung Cancer 103: 38-43
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
648131An examination of diagnostic and prognostic biomarkers in malignant pleural mesotheliomaKevin BlythScottish Executive Health Department (SEHHD-CSO)ETM/285SCHOOL OF MEDICINE, DENTISTRY & NURSING