Journal of Medical Physics
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Year : 1995  |  Volume : 20  |  Issue : 1  |  Page : 24-31

Assessment Of Lymph Node Tumour Mass From CT Scans : How Good Is Diameters And Visual Assessment

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Pratik Kumar

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The evaluation response of tumours requires quantification of tumour mass in terms of volume or maximum diameter. In normal practice changes in maximum diameter of tumour are assessed visually on follow-up CT films. This may lead to erroneous results. Twenty one patients of testicular cancer in stage I1 A to I1 D with retroperitoneal lymphadenopathy were scanned by CT for 3 to 5 times during the course of treatment. Tumour size was assessed in terms of diameter as per practice followed routinely. Avery important observation was that actual measurement of diameter instead of visual assessment resulted in change of stage of cancer in 42.8% (9 out of 21) cases. Moreover, in 6 out of these 21 cases (28%) there occurred a change in stage from I1 C to II D which assumes significance due to change in treatment protocol from BEP (Bleomycin. Etoposide, Cisplatinum) to BOP-VIP (Bleomycin, Vincristin, Cisplatinum, VP-16, Ifosfamide, Cisplatinum). Tumour volume estimated on the basis of visual method differed considerably from the calculated one. In 16 out of 21 scans, the difference was between 6.4% to 42.9%. The acceptable difference of 5% was seen only in 4 out of 21 cases indicating the importance of volume measurement. The method of volume estimation was validated and found to be within + 5% of actual volume. The correlation between diameter and volume shows that tumours with similar range of diameter have 20% to 100°/o more volume. Many times increase in diameter was found associated with actually reduced tumour volume, difference being as much as 515%. This has not been documented earlier in clinical situations. Thus, the study underscores the role of measuring the diameter of tumour for staging and highlights the need for actual volume estimationm rather than depending on maximum transverse diameter alone in follow-up studies.

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