Frequency of extrathoracic metastases from bronchogenic carcinoma in patients with normal-sized hilar and mediastinal lymph nodes on CT

The only cure for bronchogenic carcinoma is complete surgical resection; the most common reason for not attempting surgical resection is mediastinal adenopathy. However, we have found that even when the lymph nodes are normal in size, the presence of extrathoracic metastases may preclude successful resection. In a series of 263 patients with pathologically proved non-small cell bronchogenic carcinoma who were seen over a 2-year period, we identified 95 patients in whom a preoperative CT scan showed only a solitary lung mass without evidence of hilar or mediastinal metastases, pleural effusion, or definite chest-wall involvement. The medical records and preoperative imaging studies were evaluated in this group. Twenty-four (25%) of these patients who had potentially resectable masses proved to have extrathoracic metastases; thus they were not candidates for surgery. Occurring in 16 (67%) of these 24 patients, adenocarcinoma was the most common cell type; squamous cell carcinoma was present in five patients (21%), and large cell carcinoma was present in three patients (13%). These findings suggest that extrathoracic metastases from bronchogenic carcinoma may occur without CT evidence of enlarged hilar or mediastinal lymph nodes. Such metastases may preclude successful surgical resection.