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Ann Thorac Surg 1999;68:1039-1042
© 1999 The Society of Thoracic Surgeons
a Division of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan
b Department of Internal Medicine, National Cancer Center Hospital, Tokyo, Japan
Address reprint requests to Dr Nishiwaki, Division of Thoracic Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
e-mail: ynishiwa{at}east.ncc.go.jp
Abstract
Background. In the official guidelines published recently, radiographic staging procedures were not recommended for patients who have non-small-cell lung cancer with negative clinical evaluation.
Methods. We did a retrospective analysis of 755 patients with non-small-cell lung cancer in clinical stage T1–2 N0 between 1982 and 1996. The patients all had a full series of imaging procedures, based on the staging protocol. Their medical records were reviewed with respect to how often distant metastasis was detected by these procedures and whether the patients showed any symptoms and laboratory abnormalities indicating extrathoracic metastasis.
Results. The incidence of distant metastasis detected by the imaging procedures was 2.1% (nine of 419) in T1 N0 cases and 5.4% (18 of 335) in T2 N0 cases. Silent metastasis was found only in 0.5% (2 of 419) of the T1 N0 cases and 0.9% (3 of 335) of the T2 N0 cases. The cost of these staging procedures was approximately one million dollars.
Conclusions. Considering the cost and time savings, staging procedures are not warranted for patients with non-small-cell lung cancer stage T1–2 N0 with negative clinical evaluations.
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