Imaging the advancing frontier of lung cancer operability

All patients with suspected or documented lung carcinoma should be evaluated with plain films and chest CT scan. MRI should be added in cases of superior sulcus tumors and in cases where CT findings are equivocal. Neither CT nor MRI is definitive in evaluating equivocal tumor invasion of adjacent structures. Enlarged nodes identified on imaging procedures guide the clinician to the most appropriate method of obtaining tissue for staging, but are not sufficient evidence of inoperability. Complete surgical resection of the primary lesion and all involved lymph nodes is the key to improving survival in non-small cell bronchogenic carcinoma. Even in patients with ipsilateral mediastinal nodes positive for tumor, chest wall invasion, or central tumors, survival after surgical therapy (with adjuvant radiation therapy in certain cases) far exceeds survival after primary radiation therapy alone. The new International Staging System for lung cancer does not yet include the full range of surgical options to be considered in patients for whom maximal therapy is appropriate.