EXTRATHORACIC STAGING OF BRONCHOGENIC-CARCINOMA

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 than 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.