[The staging of bronchial cancer]

The variety of individual opinions encountered in the evaluation of lung cancer is due to the multiplicity of investigations. The intrathoracic extent is basically assessed by bronchial fibroscopy with tiered biopsies and computerized tomography. The specificity of computerized tomography in the evaluation of lymph node involvement never exceeds 75 per cent, and although this figure is higher as regards mediastinal or direct chest wall involvement, it never reaches 100 per cent. The information provided by magnetic resonance imaging is not better. Metastatic extension is evaluated by abdominal ultrasonography and computerized tomography of the brain and of the upper abdomen. Systematic radionuclide bone scanning is debatable and some other examinations must be reserved to certain histological types; this is the case with bone marrow biopsy (completed, if necessary, by monoclonal antibodies) or magnetic resonance imaging of bones in small cell carcinomas. The levels of some markers are well correlated with tumoral dissemination.