Staging des Bronchialkarzinoms

Abstract

Staging of any tumor, i.e. determination of the extent of the disease, serves to select the patients who might profit from curative surgical intervention or to define those patients with inoperable carcinomas who should be referred for other therapies, such as chemotherapy or irradiation. Furthermore, accurate staging is necessary for assessment of prognosis, for radiation therapy planning, and for differentiation of those with small-cell lung cancer or for follow-up examinations of small-cell lung cancer patients after during and after chemotherapy. The primary radiological staging and diagnostic modalities for assessment of bronchial carcinomas are computed tomography (CT) of the thorax including liver and adrenal glands, abdominal sonography, and bone scintigraphy. Magnetic resonance imaging (MRI) should be reserved for specific indications, e.g. infiltration of the chest wall or staging of patients with intolerance/allergy to intravenous contrast medium. The clinical value of nuclear medicine techniques, such as [18F]2-fluoride-2-desoxy-D-glucose positron emission tomography (FDG-PET) for evaluation of lymph nodes and distant metastases, In-111 octreotide/somatostatin receptor scans for staging of small-cell lung cancer, and thallium-201 SPECT are currently being assessed in numerous studies, although these techniques are already in routine use. In future these or nuclear medicine techniques, as well as techniques using molecular-based contrast material, especially for MR imaging, currently in experimental status, may yield serious potential for staging purposes.

Konventionelle radiologische Diagnostik

“…Beim klinisch-neurologisch unauffälligen Patienten mit Bronchialkarzinom erscheint die CT-oder MRT-Untersuchung des Schädels nicht indiziert, da sie nur in den seltensten Fällen einen positiven Befund erheben wird. Anders beim neurologisch auffälligen Patienten, bei dem die MRT Hirnmetastasen sensitiver nachweist als die CT (Wunderbaldinger et al 1999;Salomaa 2000;Sachs 2003).…”