The current recommendation is that routine scanning procedures to detect metastatic lesion is not necessary for brain, liver, and bones if there is no symptom or physical finding referable to the organ, and the chemistry profile is normal. Routine CT scan of the adrenals is done as there is no good historical fact, physical finding, or lab data that correlates with the presence of metastasis. Silvestri et al report in 1995, that in evaluating 3089 imaging scans, the mean negative predictive value of the clinical evaluation for CT brain (95%), abdomen (94%) and bone (89%)
However, in clinical practice, oncologists routinely would do liver and head CT to rule out a metastatic lesion prior to sending a patient for surgery. All of us have had experience of being called for a clincal presentation with brain metastasis, two to three weeks following "curative" surgery; in whom a preoperative CT of the head had not been obtained. We probably do not perform as good a neurological exam as we should.
My Recommendation:
Do a CT of the head and liver routinely as a preoperative staging procedure for patients who are operable candidates. The test is simple and one could avoid an unnecessary surgery. Routine bone scanning is not recommended, as large number of them have non- specific abnormalities and biopsy procedures are not that simple.
Ref: Chest.107(6suppl):294s-297s,1995.Am J of Resp & crit care med.152(1):225-30,1195.
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