I thank Chauvin and colleagues for bringing their article entitled "Pretreatment Staging Evaluation in Small-Cell Lung Carcinoma"1 to our attention. It is gratifying to see that a sequential staging system is effective in another population of patients with small-cell lung cancer. In their letter, Chauvin et al2 addressed a number of similarities and differences between their study and the one published by us in the February issue of the Archives.3 I would like to address these issues herein.
The basic difference between the two retrospective studies is that our criteria of diagnosis of extensive disease involved identification of an actual organ site with metastatic disease either by means of imaging studies or by biopsy procedure. We used patient history and physical examination to identify two sites of disease, namely, the central nervous system and soft-tissue disease, to preferentially select the initial investigations to perform. Patients who were