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Radionuclide Scans and Lung Cancer

Stephen I. Schabel, MD; Gerald M. Rittenberg, MD; R. Duane Holland, MD
JAMA. 1979;242(20):2178. doi:10.1001/jama.1979.03300200010002.
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To the Editor.—  We read the work of Gravenstein et al (241:2523, 1979) on the use of radionuclide imaging procedures in the evaluation of carcinoma of the lung. We disagree, however, with their conclusion that radionuclide scans should not be performed routinely.Any diagnostic procedure must be judged by whether its results will alter patient care, whether any risks are likely to be outweighed by potential benefits, and, with the increasing emphasis on the cost of medical care, whether the cost-benefit ratio is favorable. As pointed out by Grevenstein et al, 85% to 90% of patients with carcinoma of the lung have distant spread at the time of diagnosis. Many will have detectable metastatic disease to the brain, liver, and bone, without clinical symptoms. Clinically inapparent brain metastases were found in three of the 114 patients in the series reported by the authors.Thoracotomy for lung cancer carries a significant

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