Chest
Volume 102, Issue 6, December 1992, Pages 1748-1751
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Clinical Investigations
The Relationship of Clinical Findings to CT Scan Evidence of Adrenal Gland Metastases in the Staging of Bronchogenic Carcinoma

https://doi.org/10.1378/chest.102.6.1748Get rights and content

Objective

To determine whether, during the staging of newly diagnosed bronchogenic carcinoma, clinical indicators predict the presence or absence of adrenal metastases detected by computerized tomographic (CT) scans.

Design

Retrospective review of charts and roentgenograms.

Setting

Academic medical center.

Patients

Two hundred five consecutive patients diagnosed with bronchogenic carcinoma, of whom 173 had sufficient data available for analysis.

Measurements

Charts were reviewed for abnormalities in three clinical categories (signs, symptoms, and routine laboratory tests) and the presence of extrapulmonary tumor spread. The CT scans were reviewed for evidence of adrenal involvement by radiologists blinded to clinical findings. Main Results: Thirty patients had abnormal adrenal glands on CT scan. In 26 the abnormality was believed to represent adrenal metastasis, whereas in four the CT findings were consistent with adrenal adenomas. The frequency of adrenal metastases varied with the number of positive clinical findings (χ2=105.4; p<0.001). All 26 patients with adrenal metastases had at least one clinical abnormality, and 21 (81 percent had abnormalities in either two or ail three clinical categories. In 40 patients without any clinical indicators of widespread disease, none had CT evidence of adrenal metastases. The presence of adrenal metastases also varied with the extent of coexistent disease (χ2=111.82; p<0.001). Eighty-one percent (21) of the patients with and 18 percent of those without adrenal metastases had both intrathoracic and extrathoracic involvement.

Conclusions

Our findings indicate that adrenal metastases are found in patients with a large tumor burden who have clinical indicators of widespread disease. We found no evidence of adrenal metastases by CT in any patient with a normal clinical evaluation. We conclude that CT scans through the adrenal glands are unnecessary when staging newly diagnosed bronchogenic carcinoma if the findings from the initial clinical evaluation are normal.

Section snippets

Materials and Methods

All patients with histologically or cytologically proven bronchogenic carcinoma diagnosed at the Dartmouth-Hitchcock Medical Center (which includes the Mary Hitchcock Memorial Hospital, Lebanon, NH, and the VA Hospital, White River Junction, Vt) between January 1989 and December 1990 were eligible for this study. Patients who had bronchogenic carcinoma diagnosed elsewhere and who were secondarily referred to our medical center for management were excluded. The clinical records of eligible

Results

Two hundred and five patients were eligible for this study. Thirty-two were excluded for the following reasons: 13 had incomplete records, and 19 had either no CT scan performed or a CT scan which did not visualize the adrenal glands. Six of the 19 patients did not have CT scans performed because they had stage I disease and were taken directly to thoracotomy. Of the 173 remaining patients, 133 were male and 40 were female subjects. The distribution of patients by both histologic stage and

Discussion

This study describes the results of adrenal CT imaging and clinical evaluation in 173 consecutive patients with proven bronchogenic carcinoma. All 26 patients with adrenal metastases detected by CT had symptoms, signs, and routine laboratory tests indicative of widespread disease. Conversely, no adrenal metastases were found by CT in the 40 patients who had no clinical findings suggesting extensive tumor spread. These findings support the hypothesis that in bronchogenic carcinoma, CT detectable

Acknowledgments

We thank Drs. Harold Manning, Andrew Filderman, and Donald Mahler for their helpful suggestions, and Ms. Mitzi Huneven for the preparation of this manuscript.

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    Manuscript received February 7; revision accepted April 6.

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