HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Silvestri, G. A. Articles by Detterbeck, F. Search for Related Content PubMed PubMed Citation Articles by Silvestri, G. A. Articles by Detterbeck, F.

The Noninvasive Staging of Non-small Cell Lung Cancer^*

The Guidelines

^* From the Medical University of South Carolina (Drs. Silvestri and Barker), Charleston, SC; Yale University School of Medicine (Dr. Tanoue), New Haven, CT; University of Pennsylvania (Dr. Margolis), Philadelphia, PA; and University of North Carolina (Dr. Detterbeck), Chapel Hill, NC.

Correspondence to: Gerard A. Silvestri MD, FCCP, Associate Professor of Medicine, Medical University of South Carolina, Charleston, SC; e-mail: silvestri{at}musc.edu

Correctly staging lung cancer is extremely important because the treatment options and the prognosis differ significantly by stage. Several noninvasive imaging studies are available to aid in identifying disease both within and outside of the chest. Chest CT scanning is useful in providing anatomic detail that better identifies the location of the tumor, its proximity to local structures, and whether or not lymph nodes in the mediastinum are enlarged. Unfortunately, the accuracy of chest CT scanning in differentiating benign from malignant lymph nodes in the mediastinum is unacceptably low. Whole-body positron emission tomography (PET) scanning provides functional information on tissue activity and has much better sensitivity and specificity than chest CT scanning for staging lung cancer in the mediastinum. In addition, metastatic disease can be detected by PET scan. Still, positive findings of PET scans can occur from nonmalignant etiologies (eg, infections), so that tissue sampling to confirm the suspected malignancy must be performed. The clinical evaluation tool, which is composed of a thorough history and physical examination, remains the best predictor of metastatic disease. If the findings from the clinical evaluation are negative, then imaging studies such as a CT scan of the head, a bone scan, or an abdominal CT scan are unnecessary, and the search for metastatic disease is complete. If signs, symptoms, or findings from the physical examination suggest the presence of malignancy, then sequential imaging, starting with the most appropriate study based on the clues obtained by the clinical evaluation, should be performed. Abnormalities detected by all of the aforementioned imaging studies are not always cancer. Unless overwhelming evidence of metastatic disease is present on an imaging study, in situations in which it will make a difference in treatment, all abnormal scan findings require tissue confirmation of malignancy so that patients are not precluded from having potentially curative surgery.

Key Words: CT scan • lung cancer • mediastinum • metastases • noninvasive • positron emission tomography • staging

This article has been cited by other articles:

				V. Bandi, W. Lunn, A. Ernst, R. Eberhardt, H. Hoffmann, and F. J. F. Herth Ultrasound vs CT in Detecting Chest Wall Invasion by Tumor: A Prospective Study Chest, April 1, 2008; 133(4): 881 - 886. [Abstract] [Full Text] [PDF]

				K. E. Posther, L. M. McCall, D. H. Harpole Jr., C. E. Reed, J. B. Putnam Jr., V. W. Rusch, and B. A. Siegel Yield of Brain 18F-FDG PET in Evaluating Patients with Potentially Operable Non-Small Cell Lung Cancer J. Nucl. Med., October 1, 2006; 47(10): 1607 - 1611. [Abstract] [Full Text] [PDF]

				R. F. Munden, S. S. Swisher, C. W. Stevens, and D. J. Stewart Imaging of the Patient with Non-Small Cell Lung Cancer Radiology, December 1, 2005; 237(3): 803 - 818. [Abstract] [Full Text] [PDF]

				M. A. Eloubeidi, A. Tamhane, V. K. Chen, and R. J. Cerfolio Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Patients With Non-Small Cell Lung Cancer and Prior Negative Mediastinoscopy Ann. Thorac. Surg., October 1, 2005; 80(4): 1231 - 1239. [Abstract] [Full Text] [PDF]

				M. A. Eloubeidi, R. J. Cerfolio, V. K. Chen, R. Desmond, S. Syed, and B. Ojha Endoscopic Ultrasound-Guided Fine Needle Aspiration of Mediastinal Lymph Node in Patients With Suspected Lung Cancer After Positron Emission Tomography and Computed Tomography Scans Ann. Thorac. Surg., January 1, 2005; 79(1): 263 - 268. [Abstract] [Full Text] [PDF]

				C. E. Reed, D. H. Harpole, K. E. Posther, S. L. Woolson, R. J. Downey, B. F. Meyers, R. T. Heelan, H. A. MacApinlac, S.-H. Jung, G. A. Silvestri, et al. Results of the American College of Surgeons Oncology Group Z0050 trial: the utility of positron emission tomography in staging potentially operable non-small cell lung cancer J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 1943 - 1951. [Abstract] [Full Text] [PDF]