Computerized axial tomography in the pretreatment assessment of small-cell carcinoma of the bronchus.

Computerized axial tomographic scans (CAT scans) of thorax and abdomen were used as part of the initial staging procedure of 50 consecutive patients with small-cell bronchogenic carcinoma (SCBC). The aims were to define the extent of the primary tumor and metastatic spread, and to compare the information obtained from CAT scans with conventional staging procedures. With CAT scanning, spread of the primary tumor was found to be far more extensive than originally believed when defined by conventional assessment. Of 35 patients conventionally staged as localized T1 or T2 tumors, 27 (77%) had their stage increased to extensive T3 disease. similarly, subcarinal lymph nodes were found in one patient when conventional methods were used (2%), but 16 patients (32%) were found when CAT scan was used. Unsuspected adrenal metastases were found in eight patients (16%) and retrocrural nodes in four patients (8%). Thirty-seven patients (74%) were found to have Stage III tumors when conventional staging was used; 47 patients (94%) were found to be Stage III following CAT scanning, demonstrating that, within the thorax, localized tumors are very uncommon. CAT scanning demonstrates the degree of intrathoracic spread very clearly, and has a valuable role in the initial investigation of patients with SCBC if the planned treatment includes radiotherapy.