Department of Radiation Oncology, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202, USA.
Am J Clin Oncol. 2010 Jun;33(3):262-4. doi: 10.1097/COC.0b013e3181a76a3d.
In most institutions, planning computed tomography (CT) scans are not interpreted by diagnostic radiologists. The purpose of this analysis was to determine the percentage of cases in which a previously undetected radiographic finding was found on review of CT simulation images by diagnostic radiology.
At the Henry Ford West Bloomfield Center, CT simulations are prospectively interpreted by diagnostic radiologists and a formal report is generated. CT simulation scan reports of 332 consecutive breast cancer patients from 2000 to 2006 were reviewed. The percentage of these reports in which a previously undetected abnormality was noted on the planning CT was determined. Prior and subsequent diagnostic CT scans were also reviewed to determine the clinical relevance of these diagnostic abnormalities.
Of 332 patients with CT simulations for breast cancer treatment planning, 52 patients (16%) had a newly detected abnormality noted. Of these, 31 patients (or 60% of the abnormal findings) were deemed by diagnostic radiology to have potentially significant findings (e.g., "can not exclude metastatic disease"), and a follow-up CT or magnetic resonance imaging scan was recommended. Abnormalities in this category included previously undetected lung nodules, liver lesions, kidney/adrenal lesions, and sclerotic bony lesions. On follow-up, however, to date, these findings have demonstrated no clinical significance, although further follow-up is needed in many patients.
In this study, a significant proportion of breast cancer patients undergoing CT planning studies were diagnosed with potential abnormalities for which follow-up was recommended by diagnostic radiology. To date, these findings have not been clinically relevant, though further follow-up is needed in many of the patients. Thus, in cases of clinical uncertainty, a diagnostic radiologist should be consulted and follow-up imaging obtained if necessary.
在大多数医疗机构中，进行 CT 扫描规划的并非诊断放射科医师，本研究旨在确定在对 CT 模拟图像进行重新评估时，诊断放射科医师发现先前未检出的放射学表现的比例。
在亨利·福特西布卢姆菲尔德中心，前瞻性地由诊断放射科医师解读 CT 模拟图像，并生成正式报告。对 2000 年至 2006 年间 332 例连续乳腺癌患者的 CT 模拟扫描报告进行回顾性分析。确定这些报告中在计划 CT 上发现先前未检出异常的比例。同时还对之前和之后的诊断 CT 扫描进行了回顾，以确定这些诊断异常的临床意义。
在 332 例乳腺癌治疗计划的 CT 模拟患者中，52 例（16%）发现新的异常。其中，31 例（或异常发现的 60%）被诊断放射科医师认为有潜在重要意义（如“不能排除转移性疾病”），建议进行后续 CT 或磁共振成像扫描。该类别中的异常包括先前未检出的肺结节、肝病变、肾/肾上腺病变和硬化性骨病变。然而，迄今为止，在这些患者中，这些发现没有显示出临床意义，尽管许多患者仍需要进一步随访。
在这项研究中，相当一部分接受 CT 规划研究的乳腺癌患者被诊断为潜在异常，诊断放射科医师建议进行随访。迄今为止，这些发现没有临床意义，但许多患者仍需要进一步随访。因此，在临床不确定的情况下，应咨询诊断放射科医师，并在必要时获取后续影像学检查。
