Chest
Clinical InvestigationsThe Relationship of Clinical Findings to CT Scan Evidence of Adrenal Gland Metastases in the Staging of Bronchogenic Carcinoma
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.
References (26)
- et al.
Bronchogenic carcinoma
J Thorac Surg
(1954) The natural history of lung cancer
Br J Dis Chest
(1979)Prospective computed tomographic scanning in the staging of bronchogenic carcinoma
J Thorac Cardiovasc Surg
(1988)- et al.
Extrathoracic staging of bronchogenic carcinoma
Chest
(1990) - et al.
Assessing resectability of lung cancer
Eur J Rad
(1990) - et al.
Staging of non-small cell bronchogenic carcinoma
Chest
(1986) - et al.
Computed tomographic scanning of the brain in initial staging of bronchogenic carcinoma
Chest
(1984) The incidence of metastasis of malignant tumors to the adrenals
Am J Cancer
(1938)- et al.
Metastases in carcinoma
Cancer
(1950) Non-small cell lung carcinoma adrenal metastases
Cancer
(1984)
Computed tomography of the brain, chest, and abdomen in the preoperative assessment of non-small cell lung cancer
Thorax
Isolated adrenal masses in non-small cell bronchogenic carcinoma
Radiology
Upper abdominal computerized tomography scanning in staging non-small cell lung carcinoma
Cancer
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Manuscript received February 7; revision accepted April 6.