Table 2.

Diagnostic staging recommendations for small cell lung cancer

Diagnosis of small cell lung carcinoma
Staging with combined VALSG and TNM AJCC 8th edition (I, A)
Baseline study
Age, tobacco use, comorbidities, complete physical examination, and ECOG PS
Complete blood analysis: Blood count, biochemistry, liver and kidney function, alkaline phosphatase, LDH
Cardiology study: Electrocardiogram +/- echocardiogram
Respiratory function testing in patients expected to receive locoregional treatment
CT with intravenous contrast (unless medically contraindicated)
Upper thoracoabdominal CT with intravenous contrast; include pelvis in advanced stages
Intravenous contrast improves the definition of central tumours and lymph node involvement (III, A)
18F-FDG PET/CT
18F-FDG PET/CT recommended in patients expected to undergo locoregional treatment (III, A)
Images are acquired with the patient in the radiotherapy treatment position according to consensus protocol between Nuclear Medicine and Radiation Oncology departments (IV, A)
Not recommended for restaging after chemotherapy in sequential treatment
Brain staging
Brain MRI is preferable
Brain CT with IV contrast (without contrast is inadequate)
Bone scintigraphy
Only indicated if PET/CT is not available
Abdominal MRI
Only indicated to assess uncertain liver or adrenal lesions (V, C)
Histological confirmation
Invasive tests used as appropriate according to tumour location
Follow WHO criteria for cell typing. Immunohistochemistry for differential diagnosis

VALSG: Veterans Administration Lung Study Group; TNM: Tumor-node-metastasis; AJCC: American Joint Committee on Cancer; PS: Performance status; LDH: Lactate dehydrogenase; CT: Computed tomography; PET/CT: Positron emission tomography/computed tomography; FDG: Fluorodeoxyglucose; MRI: Magnetic resonance imaging; WHO: World Health Organization.