Role of computed tomography in lung cancer staging

Computed tomography has always been an important imaging technique in lung cancer staging but, due to its well-known limitations, additional imaging and/or invasive tests are usually performed. Purpose of this review is to determine whether new developments in CT and in the other staging techniques have changed the role of CT.

Despite important technical improvements and the availability of new CT applications, the recent literature confirms the limitations of CT in staging patients with NSCLC. Most attention was given however to other invasive and noninvasive staging techniques and their accuracy in comparison with CT. It was shown that FDG-PET is very useful in the preoperative patient with NSCLC and that it is, especially in N-staging, more accurate than CT. Also combining CT or FDG-PET with EUS-FNA biopsy seems to be a good approach in some indications. Finally, the first reports on the use of integrated PET-CT scanners in lung cancer staging were published and very promising results were shown.

Computed tomography stays nevertheless the routine imaging procedure for staging patients with NSCLC although performing a PET scan in addition to this CT examination seems to be a good approach that can reduce but certainly not always avoid invasive staging procedures. Mediastinoscopy is still generally considered the standard of care when tissue needs to be obtained from suspicious nodes on FDG-PET and/or CT, although minimally invasive biopsy techniques could replace to a large extent this more invasive technique in the near future.