We cannot be certain of mediastinal extension by CT or chest x-ray unless there is definite invasion of other mediastinal structures. In many patients undergoing thoracotomy, no mediastinal extension of the tumor was detected while radiologically there was an apparent tumor extension to the mediastinum. MR is better in evaluating tumor extension to chest wall or mediastinum and should be used.
My Recommendation:
Do not hold back thoracotomy because of apparent tumor extension to the mediastinum as seen in CXR or CT. MR will be helpful in these instances. MR should be a routine study in Pancoast tumor.
Ref:Radiology.187(1):33-8,1993.Southern med journal.85(12):1260-3,1992.
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