Computerized tomography in the preoperative staging for pulmonary metastases in patients with renal cell carcinoma

Computerized tomography (CT) is the state of the art technology for pulmonary staging of many extrathoracic malignancies. From 1976 to 1990, 120 of 330 patients with renal cell carcinoma treated at our hospital underwent chest radiography and chest CT. These patients were reviewed to evaluate the role of CT in examining the chest for staging of renal cell carcinoma. Median followup was 24 months. Agreement between the 2 imaging modalities was found in 105 patients. The results of chest radiography and chest CT were normal in 82 and abnormal in 23 patients. Of the 15 patients with disagreement between the 2 studies 13 had normal chest radiography with abnormal chest CT and 2 had abnormal chest radiography with normal chest CT. The 13 patients with normal chest radiography and abnormal CT were further divided into 2 groups: 8 patients with small borderline lesions seen on CT only and 5 patients with evidence of advanced, bulky disease outside the chest at presentation. A substantial agreement, more than chance alone, between chest radiography and CT existed (p < 0.0001). Followup records and survival data have shown no significant impact as a result of the disagreement between the 2 imaging modalities on the treatment decision or ultimate outcome. Based on this information, we believe that in patients with a relatively small tumor (stage T1) a normal chest radiograph suffices for pulmonary staging. The indications for additional chest CT would include solitary nodule on chest radiograph before salvage resection of metastasis, chest symptoms suggestive of endobronchial metastasis or extensive regional disease.