TNM staging in lung cancer: Role of computed tomography

Methods for Staging Non-small Cell Lung Cancer

“…Finally, in most patients, further imaging is required even if the clinical evaluation is negative ( Fig 2 ). [11][12][13][14][15][16][17][18][19][20][21][22] In particular, PET imaging has emerged as playing a prominent role, as discussed in the next section.…”

“…[Section 2.0, 3.0] False-negative rate of a negative clinical evaluation, as compared with either further PET imaging or conventional imaging (brain MRI/CT scan, abdominal CT scan, or ultrasound and bone scan). Rates are percentages of patients with a negative clinical evaluation in whom actual distant metastases are found upon further evaluation, averaged from all available studies that published stage-specific data: stage cI-III conventional 13,[16][17][18]20 ; cIII PET scan 11,15,22 ; cI, II conventional 13,14 ; cI PET scan. 15,19,21,22,192 .…”

“…36 It is well established that abnormal symptoms, physical fi ndings, and routine blood tests in the initial clinical evaluation of patients with NSCLC are associated with a high likelihood of metas tasis. 36 In addition, the NPV of the clinical evaluation ( Fig 2 ) [11][12][13][14][15][16][17][18][19][20][21][22] is high enough in most circumstances to not warrant extrathoracic conventional scanning (bone scan, brain scan, and abdominal CT scan) if the clinical evaluation is negative (this recommendation does not apply to patients with clinical stage III and IV lung cancer, in which unsuspected metastases occur even with a negative clinical evaluation). Similarly, PET or PET-CT scan ning has been found to be useful irrespective of the fi ndings on the clinical evaluation.…”

“…21,27,30 However, confi rmation of PET scan fi ndings is essential, because PET scanning also carries a signifi cant rate of incorrect upstaging. 17 A potential harm of PET scanning is that if suspected PET scan fi ndings are not confi rmed, patients may be erroneously directed away from a potentially curative resection. In the RCTs involving PET scans, this would have occurred in 5% to 42% of patients; however, in these studies, the requirement of a defi nite confi rmation of suspicious PET scan fi ndings prevented this.…”

Non‐small‐cell lung carcinoma: Tumor characterization on the basis of flow cytometrically determined cellular heterogeneity

“…Patients Flow cytometric measurements of cellular DNA content were performed on over 150 specimens from 52 patients affected by histologically confirmed NSCLC or nonmalignant lung disease. Specimens were grouped according to their histopathological type and to the TNM system (1,13,15). The histopathological composition of the group (25) (epidermoid, adenocarcinoma, and largecell carcinoma; non-malignant lung disease) is illustrated in Table 1 together with other indications of the patients' state (sex, age, disease stage, and delayed hypersensitivity reaction to recall antigens such as protein purified derivate, candidine and trichophytine).…”