Clinical Staging of Primary Lung Cancer

¹ Cora and Webb Mading Department of Surgery and Department of Radiology, Baylor College of Medicine and the Veterans Administration Hospital and Department of Pathology, Veterans Administration Hospital, Houston, Texas

Clinical staging of primary lung cancer must be individualized to be of practical value. Most tumors are visible on the chest roentgenogram, and the potential curability is evident in most patients without further study. Sputum cytologic study and bronchoscopy with biopsy provide histologic evidence of cancer in one-third of patients, but yield no information relative to clinical stage. Mediastinoscopy can determine the presence of occult mediastinal metastasis and provide information on the histologic type of primary lung cancer present. Our study demonstrated that patients having hilar or large peripheral tumors often yielded evidence of mediastinal involvement with anaplastic carcinoma, in which the prognosis for longterm survival is poor. Those patients having peripheral tumors were subjected to thoracotomy without mediastinoscopy, and in most instances resection was accomplished. Preliminary survival figures indicate that the more unfavorable lesions were selected for mediastinoscopy, but in our cases this procedure was most helpful in precluding diagnostic thoracotomy in cases of nonresectable anaplastic or adenocarcinoma.