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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Incidental extravascular findings in computed tomographic angiography for planning or monitoring endovascular aortic aneurysm repair: Smoker patients, increased lung cancer prevalence?
Maria Antonietta Mazzei, Susanna Guerrini, Francesco Gentili, Giuseppe Galzerano, Francesco Setacci, Domenico Benevento, Francesco Giuseppe Mazzei, Luca Volterrani, Carlo Setacci
Maria Antonietta Mazzei, Susanna Guerrini, Francesco Gentili, Luca Volterrani, Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
Giuseppe Galzerano, Francesco Setacci, Carlo Setacci, Department of Medical, Surgical and Neuro Sciences, Vascular and Endovascular Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
Domenico Benevento, Vascular and Endovascular Unit, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
Francesco Giuseppe Mazzei, Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
Author contributions: All authors contributed equally to this work; Mazzei MA, Guerrini S, Gentili F, Galzerano G and Mazzei FG performed the research and wrote the manuscript; Mazzei MA, Guerrini S, Gentili F, Galzerano G, Setacci F, Benevento D and Mazzei FG contributed to the conception and design of the study and to the acquisition and interpretation of the data; Mazzei MA, Guerrini S, Gentili F and Mazzei FG contributed to the acquisition of the data; Mazzei MA revised the article critically for important intellectual content; Mazzei MA, Volterrani L and Setacci C designed the research and approved the final version for publication; all authors have read and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the University of Siena Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Maria Antonietta Mazzei, MD, Associate Professor of Radiology, Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100 Siena, Italy.
mariaantonietta.mazzei@unisi.it
Telephone: +39-05-77585700 Fax: +39-05-7744496
Received: December 27, 2016
Peer-review started: December 31, 2016
First decision: March 28, 2017
Revised: April 16, 2017
Accepted: May 30, 2017
Article in press: June 1, 2017
Published online: July 28, 2017
Processing time: 205 Days and 5.2 Hours
AIM
To validate the feasibility of high resolution computed tomography (HRCT) of the lung prior to computed tomography angiography (CTA) in assessing incidental thoracic findings during endovascular aortic aneurysm repair (EVAR) planning or follow-up.
METHODS
We conducted a retrospective study among 181 patients (143 men, mean age 71 years, range 50-94) referred to our centre for CTA EVAR planning or follow-up. HRCT and CTA were performed before or after 1 or 12 mo respectively to EVAR in all patients. All HRCT examinations were reviewed by two radiologists with 15 and 8 years’ experience in thoracic imaging. The results were compared with histology, bronchoscopy or follow-up HRCT in 12, 8 and 82 nodules respectively.
RESULTS
There were a total of 102 suspected nodules in 92 HRCT examinations, with a mean of 1.79 nodules per patient and an average diameter of 9.2 mm (range 4-56 mm). Eighty-nine out of 181 HRCTs resulted negative for the presence of suspected nodules with a mean smoking history of 10 pack-years (p-y, range 5-18 p-y). Eighty-two out of 102 (76.4%) of the nodules met criteria for computed tomography follow-up, to exclude the malignant evolution. Of the remaining 20 nodules, 10 out of 20 (50%) nodules, suspected for malignancy, underwent biopsy and then surgical intervention that confirmed the neoplastic nature: 4 (20%) adenocarcinomas, 4 (20%) squamous cell carcinomas, 1 (5%) small cell lung cancer and 1 (5%) breast cancer metastasis); 8 out of 20 (40%) underwent bronchoscopy (8 pneumonia) and 2 out of 20 (10%) underwent biopsy with the diagnosis of sarcoidosis.
CONCLUSION
HRCT in EVAR planning and follow-up allows to correctly identify patients requiring additional treatments, especially in case of lung cancer.
Core tip: Nowadays the use of high resolution computed tomography in endovascular aortic aneurysm repair (EVAR) patients planning and follow up is not recommended yet. Our study demonstrates the possibility to early diagnose lung cancer during EVAR follow-up or planning in smoker patients, overcoming the concept of dose radiation induced neoplasms, especially in over 65 years old patients.
