A correlation study of bone scanning with clinical and laboratory findings in the staging of nonsmall-cell lung cancer.

Fifty consecutive patients who had a bone scan and a diagnosis of nonsmall-cell lung carcinoma were studied, retrospectively, to determine the usefulness of bone scans in the presurgical workup. Bone scans were interpreted as positive for bone metastases if the scanning abnormality could not be explained by other causes (e.g., trauma or arthritis) or by additional studies (e.g., radiography or CT scanning). Seventeen percent of the patients whose initial clinical and laboratory findings suggested only localized resectable tumor had positive bone scans, changing treatment from surgery to more conservative therapy. Thirty-six percent of patients with no evidence of lung cancer extending to the mediastinum or beyond by CT of the chest and upper abdomen had bone scans indicating bone metastases (positive bone scan). These results suggest that bone scan adds useful information to the presurgical evaluation of patients with nonsmall-cell lung cancer. Clinical findings and/or CT of the chest and upper abdomen are not sensitive or specific enough to exclude bone metastases. Bone scan is recommended before thoracotomy for patients considered for surgery for localized, potentially resectable nonsmall-cell lung cancer.