Lung cancer staging and management: Comparison of contrast-enhanced and nonenhanced helical CT of the thorax

PURPOSE: To determine whether contrast material-enhanced helical computed t omography (CT) of the thorax and upper abdomen changes the tumor stage and management compared with nonenhanced helical CT in patients with newly diag nosed lung cancer. MATERIALS AND METHODS: During 15 months, any patient in whom lung cancer wa s strongly suspected or newly diagnosed and who was scheduled for thoracic CT was considered eligible for the study, All patients underwent nonenhance d thoracic helical CT from the lung apices through the adrenal glands and t hen contrast-enhanced thoracic helical CT from the lung apices through the entire liver. Each study was read independently; and the thoracic radiologi c stage was determined. Tissue sampling was performed and the final patholo gic stage assigned. RESULTS: Ninety-six patients had a final pathologic diagnosis of lung cance r, There was agreement in stage between the nonenhanced and contrast-enhanc ed examinations in 92 of the 96 patients. In three patients, the tumor stag e 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 st age decreased from IIIB to IIB. There was no substantial change in manageme nt 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.