[Strategy for staging non-small cell bronchial carcinoma (NSCLC) with special reference to imaging procedures]

Imaging methods, especially CT and for specific questions MRI, are an essential part of diagnosis and staging of non-small cell lung cancer. They are effective methods for the detection of unresectable tumours and avoid the necessity for further invasive examinations and explorative thoracotomies. The judgement of lymph node size by CT suffers from a limited accuracy. Nevertheless, it allows guided bronchoscopical staging biopsies of enlarged mediastinal lymph nodes (> 1 cm) and, therefore, a selective indication of mediastinoscopy. CT scans of the thorax usually are extended to the adrenal glands and the liver to exclude metastasis. Extrathoracic scanning beyond the upper abdomen and bone scintigraphy should be restricted to patients with clinical indicators or symptoms. The combined application of imaging methods, bronchoscopy, and mediastinoscopy provides better selection of surgical candidates and hence reduces the rate of unresectable operations.