Radiological diagnostics of pleura and mediastinum invasion in lung cancer patients

The purpose of this study was to analyse a correlation among lung cancer morphology, growth type, localisation and pleura as well as mediastinal invasion. Materials and methods. Data on 372 patients have been analysed. Mediastinal invasion was histologically confirmed in 128 (34.4%) patients. Aorta invasion was confirmed in 21 (5.6%), vena cava superior in 11 (2.9%), pericardium in 55 (14.8%), esophagus in 7 (1.9%), pleural involvement in 54 (14.5%), pleural fluid in 51 (13.7%) patients. Chest radiography was performed for all patients, 68 patients underwent chest CT examination. Results. The probability of mediastinal invasion increases in the cases of squamous cell, undifferentiated and small cell carcinomas (p < 0.05). Pleuritis and pleural involvement have been found predominantly in adenocarcinomas. Using CT findings of possible mediastinal invasion (a 3 cm or more mass contact with the mediastinum, the angle of contact with the aorta more than 90°, obliteration of the fat plane between mass and mediastinal structures), the sensitivity of CT identifying mediastinal invasion increases. Conclusions. Mediastinal and pleural invasion depends on the morphology of cancer. Mediastinal invasion is more common in squamous, undifferentiated and small cell carcinomas. Adenocarcinomas predominantly spread to the pleura and cause pleural fluid accumulation. CT findings such as cancer mass contact with the mediastinum more than 3 cm and the angle of contact with the aorta more than 90° raise CT sensitivity while evaluating mediastinal involvement. These CT findings could also reflect the operability of a process.