Stage IIIB

The role of magnetic resonance imaging for the evaluation of lung tumors has not been fully developed; however, the technique has been shown to be of particular value for evaluating tumors arising in the superior sulcus of the lung.

STAGE IV

The stage IV category includes only patients with evidence of distant metastasis, M1 disease. Clinical signs and symptoms of metastasis to distant organ sites usually are confirmed by imaging techniques; however, routine brain and bone scans have not proved cost-effective for patients with non-small cell lung cancer. The significance of adrenal nodules imaged on abdominal CT should be determined by biopsy. Other definitive signs and symptoms of distant metastasis need not be biopsy proved for assigning the M1 category. Positron emission tomography (PET) holds promise for making clinical estimates of metastatic disease more reliable; however, specific indications for its use and application of the findings remain understudy¹³. Ipsilateral metastasis in non-primary-tumor lobes also is designated M1-Stage IV (see pages 6 and 26).

Fig. 50: Computed tomographic scan of the abdomen showing a necrotic metastasis in the right adrenal gland (white arrow) from a primary bronchogenic carcinoma, M1, stage IV.