Lung cancer staging

Radiologic evaluation is an integral part of the staging of lung cancer. The potential for resection in cases of mediastinal invasion and other advanced disease places special demands on imaging techniques. The ability of CT or MR imaging to detect mediastinal invasion accurately is limited, and patients deserve the chance for cure by surgical resection in equivocal cases. Slight increments in improving accuracy in the evaluation of nodal disease has been shown by using different size criteria for different nodal stations and by evaluating nodal architecture or extracapsular spread. CT remains cost-effective in the overall evaluation of the patients, enabling the direction of invasive procedures and the elimination of unnecessary ones. In the evaluation of metastatic disease, most patients do not appear to benefit from bone scanning and, in a limited subset of patients, brain CT scanning should be performed.