title: The role of computed tomography in assessing pleural malignancy prior to thoracoscopy.
abstract: OBJECTIVE
  Computed tomography (CT) scanning is part of the routine diagnostic work up of patients with suspected pleural malignancy but has a wide variation in the reported sensitivity and specificity. This review was to appraise the recent literature on the utility of CT scanning.
  
  
  RESULTS
  When investigating patients for suspected pleural malignancy, the sensitivity of a malignant CT report may be higher than previously reported (68%), but the specificity seems significantly lower (78%). The predictive value of CT scanning (on all patients with pleural effusions) may be increased using a CT scoring system. Recent meta-analyses of the utility of PET give differing opinions on the value of this imaging modality. Further work needs to be done to define its place in the diagnostic pathway.
  
  
  CONCLUSIONS
  CT scoring systems may allow further risk stratification. However, a low negative predictive value of a 'negative' CT scan could lead to false reassurance and missed malignancy. PET/CT does not currently appear to add additional diagnostic value. Pulmonary emboli should be considered in all patients being investigated for clinically suspected malignant pleural disease. Respiratory physicians should be mindful of rare or unusual presentations.
authors.affiliation: Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Rob J
authors.initials: RJ
authors.lastname: Hallifax
authors.forename: Ambika
authors.initials: A
authors.lastname: Talwar
authors.forename: Najib M
authors.initials: NM
authors.lastname: Rahman
mesh_terms: D006801:Humans; D010996:Pleural Effusion / Q000000981:diagnostic imaging; D010997:Pleural Neoplasms / Q000473:pathology; D049268:Positron-Emission Tomography; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed / Q000379:methods