Detection of occult metastases in lung carcinomas: Progress and implications for lung cancer staging

The ability to detect occult regional and systemic metastases in patients w ith operable lung carcinoma could have a significant impact on the manageme nt of the disease. Here, we review the literature, including studies from o ur own laboratory, regarding the clinical significance of the presence of o ccult metastases in patients with lung: cancer. The accumulated evidence st rongly suggests that the detection of occult regional and systemic metastas es is an important predictor of disease progression. The use of this method should be considered in the future design of lung cancer clinical trials, at the very least. The detection of occult metastases should have an impact on lung cancer management; to reflect this, we propose a change in the TNM staging system to indicate the presence or absence of occult regional (lym ph node) and systemic (bone marrow) metastases. The proposed change is TNnM m, where II and m are occult nodal and bone marrow metastases status. (C) 1 998 Wiley-Liss, Inc.