Extrathoracic Staging of Bronchogenic Carcinoma

doi:10.1378/chest.97.5.1052

Chest

Volume 97, Issue 5, May 1990, Pages 1052-1058

https://doi.org/10.1378/chest.97.5.1052 Get rights and content

In assessing the value of systematic evaluation of extrathoracic extension for potentially resectable, non-small-cell bronchogenic carcinoma, a prospective study was conducted in 146 patients. The study protocol included computed tomographic (CT) scan of the brain and upper abdomen, abdominal ultrasonography, and whole-body bone scanning. The findings were matched with the clinical presentation, histologic features, and TN staging, having found out that non-small cell bronchogenic carcinoma does not follow a set pattern to metastasize. The rate of metastasis for adenocarcinoma is not only significantly larger (p<0.05) but it does not correlate with the TN staging, in contrast to what happens with the squamous cell carcinoma (p<0.01). None of the squamous cell carcinomas in intrathoracic stage I was found to metastasize. Twenty-one percent (4/19) of brain metastases were asymptomatic (three adenocarcinomas and one squamous cell carcinoma with multiorgan metastasis). Bone scanning detected metastasis in 3.4 percent (4/116) of the asymptomatic patients, and three of the four patients with asymptomatic metastasis had nonskeletal foci. In 61 percent (11/18) of patients with hepatic metastasis, we did not find organ-specific indicators to suspect it. The series showed a 7.5 percent incidence of adrenal metastasis. Our findings suggest the convenience of performing an upper abdominal CT scan and/or ultrasonography in all patients, except for those with asymptomatic stage I squamous cell carcinoma; we also suggest brain CT scanning for all patients with adenocarcinomas and large-cell carcinomas as well as for those with squamous cell carcinoma with neurologic symptoms, and whole-body bone scanning only in those patients with clinical and laboratory indication of possible bone involvement by metastatic disease.

Section snippets

MATERIALS AND METHODS

Between March 1985 and July 1987, 146 patients with potentially resectable NSCBC were prospectively subjected to evaluation for extrathoracic, neoplastic extension at the Thoracic Unit of the “Reina Sofia” Hospital, Cordoba, Spain (Table 1). The following patient categories were excluded from this study: (1) those who were first being seen because of symptoms secondary to extrathoracic presentation of the disease; (2) those with metastasis easily evaluated by means of physical examination

RESULTS

In 44 (30 percent) of 146 patients, extrathoracic metastases were detected in at least one organ, and in 17 patients (11.6 percent) the disease was multiorganic.

The metastases found were located in the following: brain, 19 cases (13 percent); bone, 19 cases (13 percent); liver, 18 cases (12.3 percent); adrenals, 11 cases (7.5 percent); kidney, two cases (1.4 percent); and subdiaphragmatic nodules, two cases (1.4 percent).

The histologic analysis revealed metastases in 42 percent (13/31) of the

DISCUSSION

The purpose of this study was to determine the value of routine extrathoracic staging in patients with potentially resectable NSCBC. In this way, the clinical and laboratory data suspect for metastasis were prospectively registered. Modern diagnostic imaging techniques were used on the organs and systems more often affected by this type of tumor. To obtain practical conclusions about what study should be done and when, every patient included in this series was subject to all techniques

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Chest

Clinical InvestigationsExtrathoracic Staging of Bronchogenic Carcinoma

Section snippets

MATERIALS AND METHODS

RESULTS

DISCUSSION

Chest

Chest

Chest

Chest

Ann Thorac Surg

J Thorac Cardiovasc Surg

Br J Dis Chest

J Thorac Cardiovasc Surg

J Thorac Surg

Frequency of residual and metastatic tumor in patients undergoing curative surgical resection for lung cancer

Cancer Chem Respir

Evaluation of the long term results of surgery for bronchial carcinoma

J Thorac Cardiovasc Surg

Biologic, physiologic and technical determinants in surgical therapy for lung cancer

A new international staging system for lung cancer

Chest

Selection and interpretation of diagnostic test and procedures

Ann Intern Med

Primer on certain elements of medical decision making

N Engl J Med

The value of routine cranial computed tomography in neurologically intact patients with primary carcinoma of the lung

Radiology

‘Silent’ brain metastases from lung carcinoma determined by computerized tomography

Arch Neurol

Asymptomatic patients with primary carcinoma: computerized cranial tomography study

NY State J Med

The use of serial bone scans in assessing response of bone metastases to systemic treatment

Cancer

Clinical Investigations
Extrathoracic Staging of Bronchogenic Carcinoma