Unsuspected abnormalities noted on CT treatment-planning scans obtained for breast and chest wall irradiation

Purpose: Three-dimensional treatment planning and CT simulation is widely u sed for the treatment of a variety of cancers. At the Stanford University M edical Center, a treatment-planning CT scan is obtained before breast irrad iation to optimize the dose distribution to the treated breast and to limit radiation to the opposite breast, heart, and lung, In this paper, we revie w the incidental findings discovered on a careful review of these scans. Methods and Materials: Between 1997 and 1999, 153 patients referred for bre ast or chest wall radiation therapy underwent a treatment-planning CT scan in our department, The planning scans were extended to include not only the breast, but also the neck, thorax, and liver. A resident and attending rad iation oncologist carefully reviewed each scan before approving the treatme nt plan. Any abnormal findings were reviewed by; an attending in the depart ment of radiology, and additional diagnostic imaging or other evaluation wa s obtained as necessary. Results: One hundred and fifty-three sequential scans were reviewed, and 17 unsuspected abnormalities were noted(11%). The abnormalities involved the lung(n = 4), the liver (n = 3), the gallbladder (n = 3;), the esophagus (n = 2), lymph nodes (n = 3), and the breast, Alt abnormalities were evaluated with additional imaging studies and/or appropriate consultations. Four of these abnormalities represented additional cancer foci (3%) and altered the treatment plan. Conclusions: Three-dimensional treatment-planning CT scans for breast cance r should be carefully reviewed, In bur institution, 11% of these planning s tudies contained abnormalities, and 3% demonstrated additional unanticipate d sites of involvement by breast cancer, (C) 2001 Elsevier Science Inc.