Table 1.
Diagnostic and staging work-up of SCLC
| History and clinical examination |
| Medical history (including smoking history and comorbidities) |
| PS |
| Physical examination |
| Assessment of paraneoplastic syndromes (especially when initiating immunotherapy) |
| Laboratory analysis |
| CBC, liver enzymes, sodium, potassium, calcium, glucose, LDH and renal functions tests should be carried out |
| Imaging |
| CT of the thorax and abdomen should be carried out in all patients; an FDG—PET—CT is optional |
| In case of a suspicion of bone metastasis and no other metastasis, a bone scintigraphy should be carried out unless FDG—PET is available Imaging of the brain (preferably MRI) is mandated in patients with stage I-III disease |
| MRI of the brain is recommended for patients with stage IV disease who are eligible for PCI but who choose not to undergo PCI |
| Tumour biopsy |
| A diagnosis of SCLC is preferably assessed based on histological examination of a biopsy |
| In case of planned surgery, invasive mediastinal staging is required |
| Functional assessment |
| Pulmonary function testing (FEV1, VC, DLCO) is required for patients with stage I-III SCLC who are candidates for surgery or RT |
| VO2 max assessment by cycle ergometry should be carried out if surgery is planned when pulmonary function tests are limited |
CBC, complete blood count; CT, computed tomography; DLCO, diffusing capacity of the lung for carbon monoxide; FDG, [18F]2-fluoro-2-deoxy-D-glucose; FEV1, forced expiratory volume; LDH, lactate dehydrogenase; MRI, magnetic resonance imaging; PCI, prophylactic cranial irradiation; PET, positron emission tomography; PS, performance status; RT, radiotherapy; SCLC, small-cell lung cancer; VC, vital capacity; VO2 max, maximal oxygen uptake.