Central lung masses: prediction with CT of need for pneumonectomy versus lobectomy

To assess the possible role of computed tomography (CT) in predicting the need for pneumonectomy rather than lobectomy, the authors retrospectively analyzed the CT scans of 26 patients requiring pneumonectomy (n = 21) or lobectomy (n = 5) for resection of central pulmonary abnormality. Twenty-three patients had primary lung cancer, two had metastatic carcinoma, and one had a massive granuloma. Scans were evaluated for tumor involvement of bronchi and pulmonary arteries and veins and for evidence of tumor extension across a fissure. Findings were compared with detailed surgical and pathologic data. Pneumonectomy was necessary most commonly because of proximal bronchial tumor invasion (13 patients). CT showed poor sensitivity (50%-54%) in depicting central bronchial and central pulmonary artery involvement as well as transfissural tumor extent. The results suggest that CT is not highly accurate in predicting the lobectomy/pneumonectomy decision in patients with central lung masses.