The geography of possible metastasis in lung cancer is extremely extensive. However, the favorite localization of tumor metastasis is the liver, adrenal glands, kidneys, skeleton bones, brain and lungs. Moreover, the organs located under the diaphragm are most often involved in the tumor process. Thus, among patients with stage IV lung cancer who died in the clinic in the period from 1977 to 1994, in 85.4% of cases, damage to the liver, kidneys, and adrenal glands was diagnosed. Therefore, if it is possible to prove the absence of metastases in these organs, the probability of a different localization of the metastatic process is significantly reduced. The most reliable information on the state of the organs below the diaphragm is represented by diagnostic laparotomy, laparoscopy, allowing the oculus to “assess the pathological focus and take material for morphological research.In recent years, in a number of clinics, these tasks are solved using video laparoscopy and. In the opinion, under the control of a laparoscope and a video monitor, lesions of up to 5 mm or less can be diagnosed.

However, being useful at the final stage of diagnosis, these methods are obviously not acceptable as routine in all patients with lung cancer in order to separate them by the M descriptor, especially in the absence of clinical and laboratory indications of process localization.

More recently, when selecting patients for diagnostic laparotomy or laparoscopy, we focused on more frequent detection of metastases in the organs below the diaphragm with undifferentiated and glandular lung cancer, and mediastinal lymph nodes. N.А. Kosenko (1988) used a special computer program and computational tables developed on the basis of a mathematical analysis of data from an ordinary clinical and radiological examination of patients to select a high-risk group. A significant drawback of this approach was the lack of indication of the localization of the metastatic process and its probabilistic nature.

Sshirokim introduction into clinical practice of radioisotope research methods, allowing not only suspect, but lokalizoval hematogenous metastases began to be considered the possibility of their use in screening patients with M 1.

However, the experience gained in our clinic and other hospitals has shown that in most cases radionuclide diagnostics do not allow for the detection of small volume lesions. When scanning the liver, the resolution of the study is reduced to 3 cm and foci located deep in the right lobe are visualized at sizes greater than 5 cm. In addition, the scan image can be of the same type with multiple small metastases, chronic hepatitis and fatty degeneration, developmental anomalies and blood filling. Negative scintigraphy does not allow to differentiate a solid focus in the liver from cystic formation and extrahepatic pathological processes leading to pressure on the liver from the outside. Tumorotropic radiopharmaceuticals along with tumor tissue are fixed in the foci of inflammation and even unchanged liver tissue.The results of the study are largely determined by the quality of the radiopharmaceutical and the technical condition of the recording equipment. Therefore, it is natural that the diagnosis of hematogenous metastases is accompanied by a large number of false-negative and false-positive (8%) findings that cannot satisfy the physician conducting the selection of patients for surgical intervention. Denial of radical treatment on the basis of a liver scan alone is a medical mistake.

However, if a metastatic bone lesion is suspected, the method has retained a priority role, allowing it to be confirmed 2– months earlier than an x-ray. Lung cancer metastases in the skeleton are more often multiple. The defeat of the thoracic and lumbar spine, pelvis and ribs is characteristic. The priority method for their diagnosis is a radionuclide study in the form of static scintigraphy. All skeleton is studied simultaneously. The duration of the procedure is 10 to 15 minutes. 99m Tc-pyrophosphate or 113m are used as a radiopharmaceutical . In-indie. The method allows to identify metastatic foci up to 1 cm in size. Its diagnostic accuracy reaches 95%. For questionable scintigraphy data, a CT scan should be performed on suspicious bone areas.