title: Preoperative computed tomography findings predict surgical resectability of thymoma.
abstract: BACKGROUND
  The aim of the study was to identify preoperative computed tomography (CT) imaging characteristics that correlated with surgical resectability.
  
  
  METHODS
  We retrospectively reviewed the CT scans of 133 patients who underwent surgical resection for thymoma at our institution between July 21, 1997, and September 22, 2010. Imaging characteristics recorded included tumor size, attenuation, contact of mediastinal vessels, tumor morphology, infiltration of surrounding fat, changes in the adjacent lung parenchyma, lymphadenopathy, and pleural involvement.
  
  
  RESULTS
  The study group included 66 men and 67 women, aged 23-88 years (mean 58.8 years). Eighty patients (60.2%) were Masaoka stage I or II and 53 (39.8%) were Masaoka stage III or IV. Twenty-three patients (17.3%) had an incomplete surgical resection. Of these, 15 patients had microscopic residual disease (11.2%) and eight had gross residual disease (6.0%). The preoperative CT characteristics that correlated with an incomplete surgical resection included a lobulated tumor contour (p = 0.016), greater than or equal 50% abutment of the circumference of an adjacent vessel (p < 0.001), thoracic lymphadenopathy (p = 0.029), adjacent lung changes (p = 0.005) and pleural nodularity (p = 0.001). Tumor size was larger in the incompletely versus completely resected groups, with mean values of 9.7 and 6.9 cm (p value 0.013). On multivariate analysis, only degree of abutment of adjacent vessels and pleural nodularity were independent predictors of incomplete resection.
  
  
  CONCLUSIONS
  Preoperative CT findings can predict the likelihood of successful surgical resection and could help to identify patients who might benefit from neoadjuvant chemotherapy.
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Hayes
authors.affiliation: Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: James
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Plodkowski
authors.affiliation: Department of Radiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY.
authors.forename: Janine
authors.initials: J
authors.lastname: Katzen
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Junting
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Chaya S
authors.initials: CS
authors.lastname: Moskowitz
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: ginsberm@mskcc.org.
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Ginsberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D010995:Pleural Diseases / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D013934:Thymectomy; D013945:Thymoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D013953:Thymus Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D055815:Young Adult