[Staging of pulmonary cancer, establishment of M1]

The rapid and widespread development of imaging techniques during the last decade has markedly modified the previous algorithms used in the staging of pulmonary carcinoma, particularly M0/M1 in the TNM classification and the directives of the American Thoracic Society. Sensitivity and specificity of each method are reviewed according to the most frequent metastatic sites of bronchopulmonary carcinoma. Presently, CT is the most efficient technique for detection and display of metastases of the contralateral lung, brain, adrenal glands and retroperitoneal lymph nodes. Ultrasound is equal or even slightly superior to CT for the detection of liver metastases. The superiority of magnetic resonance imaging (MRI) over CT in the detection of brain metastases has already been demonstrated. The results of MRI using fast sequences have recently been demonstrated for imaging of thoracic, abdominal and bone metastases, but confirmation of these first results by prospective studies is needed. Skeletal survey is still obtained by radioisotope scanning.