Limitations of CT in evaluation of neoplasms involving chest wall

We reviewed the CT of 20 patients with peripheral lung malignancies in which CT appearance suggested chest wall invasion on the basis of extension of mass around ribs into fat or muscle of the chest wall, or definite bone destruction. We correlated these findings with other radiographic studies and surgical and autopsy results. All 11 cases in which CT indicated chest wall involvement on the basis of definite bone destruction were confirmed. Tumor extension into the chest wall was disproven in six of the remaining nine cases in which invasion was suggested on the basis of tumor infiltration between ribs or extension of tumor into fat or soft tissue planes. Our findings confirm the lack of reliability of CT findings in determining the extension of malignancy into the chest wall, except when definite bone destruction is present.