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Lung Cancer Staging and Management: Comparison of Contrast-enhanced and Nonenhanced Helical CT of the Thorax¹

¹ From the Department of Radiology (E.F.P., J.J.E., H.P.M., J.E.C., E.M.M., P.C.G., R.A.L., M.T.K.) and Biometry Division, Community and Family Medicine (J.E.H.), Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710. Received May 20, 1998; revision requested June 18; final revision received September 2; accepted December 15. Address reprint requests to E.F.P. (e-mail: patz0002@mc.duke.edu).

PURPOSE: To determine whether contrast material–enhanced helical computed tomography (CT) of the thorax and upper abdomen changes the tumor stage and management compared with nonenhanced helical CT in patients with newly diagnosed lung cancer.

MATERIALS AND METHODS: During 15 months, any patient in whom lung cancer was strongly suspected or newly diagnosed and who was scheduled for thoracic CT was considered eligible for the study. All patients underwent nonenhanced thoracic helical CT from the lung apices through the adrenal glands and then contrast-enhanced thoracic helical CT from the lung apices through the entire liver. Each study was read independently, and the thoracic radiologic stage was determined. Tissue sampling was performed and the final pathologic stage assigned.

RESULTS: Ninety-six patients had a final pathologic diagnosis of lung cancer. There was agreement in stage between the nonenhanced and contrast-enhanced examinations in 92 of the 96 patients. In three patients, the tumor stage at nonenhanced CT increased at contrast-enhanced CT, from IA to IIA (n = 1), IIB to IV (n = 1), and IIIB to IV (n = 1). In one patient, the tumor stage decreased from IIIB to IIB. There was no substantial change in management of any patient.

CONCLUSION: The results suggest that contrast-enhanced thoracic CT through the liver for staging lung cancer rarely changes the tumor stage determined with nonenhanced CT through the adrenal glands and does not substantially influence management decisions.

Index terms: Computed tomography (CT), comparative studies, 60.12111, 60.12112, 60.12115, 76.12111, 76.12112, 76.12115, 86.12111, 86.12112, 86.12115 • Computed tomography (CT), helical, 60.12115, 76.12115, 86.12115 • Lung, CT, 60.12111, 60.12112, 60.12115 • Lung neoplasms, 60.321, 60.334, 60.3313, 60.3376, 60.3386 • Lung neoplasms, staging, 60.33

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