T1N0M0 bronchogenic carcinoma: assessment by CT.

Abstract

We reviewed medical records and conventional chest radiographs that showed a solitary T1N0M0 nodule in 23 patients who had non-oat-cell bronchogenic carcinoma. No patient had evidence of metastases, either on the chest radiograph or clinically. All patients underwent computed tomography (CT) examination of the thorax, including the adrenal glands. Only one patient (4%) had mediastinal lymph nodes greater than 1 cm in diameter accessible to mediastinotomy; anterior mediastinotomy confirmed metastatic spread in this patient, which precluded curative resection. Three patients each had a mildly enlarged (2 cm or less) adrenal gland; however, follow-up study suggested that metastasis was not the cause of adrenal enlargement in these patients. This study reinforces concern over whether CT is warranted in the preoperative assessment of T1N0M0 bronchogenic carcinoma.

Methods for Staging Non-small Cell Lung Cancer

“…A unilateral adrenal mass in a patient with NSCLC is more likely to be a metastasis than a benign lesion according to some, 36,80 but not other, studies. 81,82 In the presence of clinical T1N0, NSCLC adenomas predominate, 83,84 whereas adrenal metastases are frequently associated with large intrathoracic tumors or other extrathoracic metastases. 36,85 Many studies suggest that the size of a unilateral adrenal abnormality on a CT scan is an important predictor of metastatic spread, but this is not a universal fi nding.…”

The practice of cardiothoracic surgeons in the perioperative staging of non-small cell lung cancer.

“…They will include non-availability of computed tomography as well as reasoned decisions not to scan patients with peripheral tumours and a radiographically normal mediastinum, whose chances of having undetected N2 disease are low. [18][19][20] Nevertheless, 44% of surgeons who do not perform either routine computed tomography or preoperative mediastinal sampling in theory may embark on a thoracotomy unaware of the state of the patient's mediastinal nodes. This figure is almost certainly an overestimate for the reasons indicated above and because many patients referred to thoracic surgical units will already have been scanned.…”

Staging intrathoracic non-small-cell lung cancer

“…Unsuspected nodal disease is present in up to 21 % of such cases [96][97][98][99][100][101]. With low prevalence of nodal metastases, the potential for false-positive CT diagnoses is increased.…”