Extrathoracic staging of non-small cell bronchogenic carcinoma: relationship of the clinical evaluation to organ scans

OBJECTIVE: The aim of this study was to investigate the value of systemic evaluation of extrathoracic extension of non-small cell lung cancer and to assess the value of the clinical evaluation in detecting extrathoracic metastases. METHODOLOGY: The study included 90 patients 87 men, three women; mean age 57.5 years (range 28-76)] with potentially resectable non-small cell carcinoma. Fifty-two were squamous cell carcinomas and 38 were adenocarcinomas. Organ-specific and non-organ-specific clinical findings suggesting metastases were analysed and computed tomographic scans of the brain and abdomen and whole-body bone scanning were performed in all patients. RESULTS: Extrathoracic metastases were detected in 23 (25.5%) of 90 patients. The metastases were located in the following areas: brain (n = 12, 13.3%); bone (n = 9, 10%); liver (n = 5, 5.6%); and adrenal gland (n = 5, 5.5%). Histological analysis revealed metastases in 21.1% (11/52) of the squamous cell carcinomas and 31.6% (12/38) of the adenocarcinomas (P > 0.05). Eleven (47.8%) of the 23 patients with extrathoracic metastases had no organ-specific clinical findings suggesting metastases. Eight patients with squamous cell carcinomas were intrathoracic T1N0 stage and in two (25%) of these patients extrathoracic metastases were detected. These patients had no organ-specific or non-organ-specific clinical factors suggesting metastases. CONCLUSIONS: Evaluation of extrathoracic extension should be routinely performed in all patients with newly diagnosed lung cancer. This approach will prevent many unnecessary thoracotomies.