What is the role of CT scanning in determining chest wall invasion of the primary tumor for lung cancer staging?

Updated: Jan 28, 2019
  • Author: Omar Lababede, MD; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

The invasion of the chest wall can be reliably detected by CT only in cases with gross soft tissue or osseous involvement. Otherwise, CT is limited in assessing such invasion in less overt cases with contact between the mass and the chest wall. Detecting chest wall invasion by lung tumor is important for preoperative evaluation and planning. Although such invasion does not exclude surgery, it may alter the surgical approach. The following CT findings can suggest but do not confirm the invasion of the parietal pleura and chest wall:

  • Length of contact between the lesion and the chest wall of more than 3 cm

  • Relatively large area of contact between the mass and the chest wall, with the ratio of the lesion's diameter to the length on contact of more than 0.5

  • Obliteration of the extrapleural fat plane

  • Obtuse angle and/or pleural thickening at the margin of contact between the lesion and the pleura


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