title: Diagnostic yield of preoperative computed tomography imaging and the importance of a clinical decision for lung cancer surgery.
abstract: OBJECTIVE
  This study aimed to evaluate the diagnostic yield of preoperative computed tomography (CT) imaging and the validity of surgical intervention based on the clinical decision to perform surgery for lung cancer or suspected lung cancer.
  
  
  METHODS
  We retrospectively evaluated 1755 patients who had undergone pulmonary resection for lung cancer or suspected lung cancer. CT scans were performed on all patients. Surgical intervention to diagnose and treat was based on a medical staff conference evaluation for the suspected lung cancer patients who were pathologically undiagnosed. We evaluated the relation between resected specimens and preoperative CT imaging in detail.
  
  
  RESULTS
  A total of 1289 patients were diagnosed with lung cancer by preoperative pathology examination; another 466 were not pathologically diagnosed preoperatively. Among the 1289 patients preoperatively diagnosed with lung cancer, the diagnoses were confirmed postoperatively in 1282. Among the 466 patients preoperatively undiagnosed, 435 were definitively diagnosed with lung cancer, and there were 383 p-stage I disease patients. There were 38 noncancerous patients who underwent surgery with a diagnosis of confirmed or suspected lung cancer. Among the 1755 patients who underwent surgery, 1717 were pathologically confirmed with lung cancer, and the diagnostic yield of preoperative CT imaging was 97.8%. Among the 466 patients who were preoperatively undiagnosed, 435 were compatible with the predicted findings of lung cancer.
  
  
  CONCLUSIONS
  Diagnostic yields of preoperative CT imaging based on clinical evaluation are sufficiently reliable. Diagnostic surgical intervention was acceptable when the clinical probability of malignancy was high and the malignancy was pathologically undiagnosed.
authors.affiliation: Division of Chest Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-cho, Niigata, 951-8566, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Sato
authors.forename: Teruaki
authors.initials: T
authors.lastname: Koike
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yamato
authors.forename: Katsuo
authors.initials: K
authors.lastname: Yoshiya
authors.forename: Nozomu
authors.initials: N
authors.lastname: Motono
authors.forename: Mariko
authors.initials: M
authors.lastname: Takeshige
authors.forename: Naoya
authors.initials: N
authors.lastname: Koizumi
authors.forename: Keiichi
authors.initials: K
authors.lastname: Homma
authors.forename: Hiroko
authors.initials: H
authors.lastname: Tsukada
authors.forename: Akira
authors.initials: A
authors.lastname: Yokoyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult