Resectable stage III lung cancer: CT, surgical, and pathologic correlation

The new International Staging System identifies a subset of patients with stage III lung cancer who have improved survival rates after surgical resection. The computed tomographic (CT), surgical, and pathologic findings in 26 patients with completely resected stage IIIa lung cancer were reviewed. Preoperative CT scans accurately demonstrated chest wall invasion in only two of ten patients with chest wall or diaphragmatic invasion. CT demonstrated pericardial involvement in only one of three patients. Tumor extension to within 2 cm of the tracheal carina was seen with CT in one of three patients. Eleven of 26 patients had limited ipsilateral mediastinal (N2) disease; eight of 11 had affected nodes greater then 10 mm on CT scans. As previously shown, CT is of limited value in the assessment of chest wall, mediastinal, pleural, or pericardial tumor extension; however, such extension does not preclude complete resection. Ipsilateral node involvement does not preclude surgery. Familiarity with the new staging system and awareness of what constitutes potentially resectable disease are necessary for an adequate assessment of CT findings.