[Methods and problems in staging bronchial carcinomas]

The evaluation of size and histological type of primary tumors of the lung and of the draining regional lymph nodes needs a very extensive diagnostic program. This means a standardized basic program (case history, physical examination, laboratory diagnosis, X-rays of the chest, cytologic evaluation of the sputum, and bronchoscopy), and further examination depending on the findings in the individual patients (lung scan, mediastinoscopy, needle biopsy, angiography, thoracoscopy, and sometimes diagnostic thoracotomy). Looking for distant metastases it is necessary to investigate the most frequently involved organs: the liver (sonography, scan, CAT scan, laparoscopy), the skeleton (scan, X-ray, biopsy), the central nervous system (CAT scan, electroencephalogram, liquor cytology, myelography), and the retroperitoneal space (sonography, CAT scan). It is absolutely necessary to follow this program in patients with small cell carcinoma. Contrary, in patients with other types of lung cancer the whole diagnostic program is indicated when clinical signs evoke suspicion of metastases. The limits of the different diagnostic procedures are discussed.