Computed tomography in the pre-operative assessment of mediastinal tumours--does it improve surgical management?

Computed tomography (CT) provides detailed imaging of the mediastinum. To assess whether this information improves subsequent surgical management 39 consecutive cases were reviewed. 21 patients had pre-operative CT of the mediastinum (CT group); 18 did not (No-CT group). The pre-operative use of CT resulted in the correct assessment of tumour consistency in 20 patients, the correct extent of invasion in 16, and the correct diagnosis in 10. In 15 of the 39 cases the surgical management was inappropriate because exploration was performed for an inoperable tumour, where no tumour was found, or when nonsurgical treatment was indicated. The number of inappropriate procedures was significantly lower in the CT group. These results suggest that the routine use of CT in the assessment of mediastinal tumours is justified by a subsequent improvement in surgical management.