Preoperative staging of non-small-cell carcinoma of the lung: imaging methods

Preoperative tumor staging in patients with non-small-cell lung cancer is important for selecting those patients with localized disease who are likely to benefit from surgical resection. The TNM staging system of the American Joint Committee on Cancer is the most widely accepted and used classification system for preoperative and postoperative staging [1] (Table 1). Small-cell carcinoma has a very different biologic behavior and is classified and treated differently; it will not be discussed in this imaging review. Chest radiography is the preferred initial imaging technique for patients with known or suspected lung cancer because of its availability, low cost, low radiation dose, and sensitivity [2]. CT and MR imaging of the chest and abdomen are often used to stage a known or suspected lung carcinoma. Various nuclear medicine procedures may be used to aid in the staging process and to assess the patient's medical status for surgery, including cardiac and pulmonary function. This article reviews the major imaging techniques that are currently used to stage primary non-small-cell carcinoma of the lung. Although evaluation of distant metastatic disease is highly important in these patients, discussion of the imaging methods used for this purpose is beyond the scope of this article.