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J Thorac Cardiovasc Surg 2003;125:1300-1305
© 2003 The American Association for Thoracic Surgery

General Thoracic Surgery

Usefulness of low-dose spiral CT of the chest in regular follow-up of postoperative non-small cell lung cancer patients: Preliminary report

From the Chest Department,^a Department of Radiology,^b and Section of Thoracic Surgery, Department of Surgery,^c Taipei Veterans General Hospital, Taipei: and School of Medicine, National Yang-Ming University,^d Taipei, Taiwan, Republic of China.

This study was supported by grants from the National Science Council of the Republic of China (NSC90-2314-B-075-056) and the Medical Research and Advancement Foundation in Memory of Dr Chi-Shuen Tsou.

Received for publication July 15, 2002. Revisions requested Aug 22, 2002; revisions received Aug 27, 2002. Accepted for publication Sept 11, 2002. Address for reprints: Shi-Chuan Chang, MD, Chest Department, Taipei Veterans General Hospital, 201 Section 2, Shih-Pai Road, Shih-Pai, Taipei 112, Taiwan, ROC (E-mail: scchang{at}vghtpe.gov.tw)

Objectives: There is no consensus for the best postoperative follow-up in patients after complete resection of non-small cell lung cancer. Low-dose computed tomography of chest proves valuable in screening primary lung cancer and may be a useful tool in postoperative surveillance.
Methods: In part 1, 30 patients who underwent surgical resection of non-small cell lung cancer and were at the first (n = 14), second (n = 9), or fifth (n = 7) annual postoperative surveillance were selected chronologically and subjected to chest radiography, low-dose computed tomography, and standard-dose computed tomography to verify the diagnostic accuracy of low-dose computed tomography. In part 2, 43 patients were prospectively enrolled and followed up regularly after complete resection of non-small cell lung cancer. The follow-up protocol included physical examination, sputum cytology, serum carcinoembryonic antigen, chest radiography, and low-dose computed tomography every 3 months in the first 2 years postoperatively until tumor recurrence.
Results: In part 1, tumor recurrence was detected by standard-dose computed tomography in 7 cases. Low-dose computed tomography and chest radiography missed 1 and 5 of 7 cases, respectively. In part 2, tumor recurrence was found in 14 cases with 19 metastatic sites. Thirteen of the 14 (92.9%) cases were detected by scheduled visiting and 11 (78.6%) detected by low-dose computed tomography including the 7 without symptoms. Of the 19 recurrent sites found in 14 patients, 11 ones (57.9%) were detected by low-dose computed tomography.
Conclusions: Low-dose computed tomography may be of considerable value in early detection of tumor recurrence in postoperative non-small cell lung cancer patients. Further large prospective studies are needed to verify this issue.