Squamous cell carcinoma of the lung Diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2] Trusha Tank, M.D.[3]
Overview
Computed tomography is the method of choice for the diagnosis of squamous cell carcinoma of the lung. On CT, findings of squamous cell carcinoma of the lung will depend on the location of the tumor. Characteristic findings include ground-glass opacity, rounded or spiculated mass, local nodal involvement, intraluminar obstruction, and lobar collapse. The staging of lung cancer is based on the TNM classification of lung cancer. Lung cancer staging is an assessment of the degree of spread of cancer from its original source. It is an important factor affecting the prognosis and potential treatment of lung cancer. Non-small cell lung carcinoma is staged from IA ("one A", best prognosis) to IVB ("four B", worst prognosis). Biopsy findings associated with squamous cell carcinoma of the lung include prominent nucleoli, eosinophilic cytoplasm, and intracellular bridges. Different sub-types of lung tissue biopsy for squamous cell carcinoma of the lung, include: needle biopsy, open biopsy, and video-assisted thoracoscopic surgery.
Diagnostic Study of Choice
Study of Choice
- CT is the modality of choice for the evaluation of possible squamous cell carcinoma of the lung
- Certain morphological features can be suggestive of squamous cell carcinoma of the lung, such as:[1][2]
- Cavitation, usually secondary to tumoral necrosis
- Central scar
- Usually measure larger than 4 cm in diameter
- CT features involved in the diagnosis of squamous cell carcinoma of the lung include:
- Staging of the disease
- Dictation of the prognosis and treatment
- CT findings of squamous cell carcinoma of the lung, include:
- Central location
- Intraluminal obstruction
- Lung collapse and/or obstructive pneumonitis
- Ground-glass opacity
- Rounded or spiculated mass
- Local nodal involvement
- Intraluminar obstruction
- Segmental or lobar lung collapse
- Peripheral location
- Solid nodule/mass with or without an irregular border
- Irregular margins
- Desmoplastic reaction or infiltrative growth
- Similar to central lung cancer, peripheral squamous cell carcinoma of the lung can also result in obstructive changes such as a mucocele.
- Finger in glove sign: the bronchus distal to the obstruction is dilated
- Crazy-paving sign: appearance of ground-glass opacity with superimposed interlobular septal thickening and intralobular reticular thickening
Gallery
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Bronchogenic lung carcincoma: upper lobe collapse via, radiopedia.org Case courtesy of Dr Ahmed Abdrabou, [4]
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Bronchogenic lung carcincoma: upper lobe with lymphangitic spread via, radiopedia.org Case courtesy of Dr Ahmed Abdrabou, [5]
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Squamous cell lung carcinoma: Peripheral squamous cell lung carcinoma may be seen as a solid nodule/mass with or without an irregular border. The irregular margin can be attributed to a desmoplastic reaction or infiltrative growth via, radiopedia.org Case courtesy of Dr Bruno Di Muzio, [6]
Staging
The following is 2017 TNM classification of lung cancer.[7][8][9]
T: Primary Tumor
T | Description |
TX | Primary tumor cannot be assessed. OR Tumor is demonstrated by the presence of malignant cells in bronchial washings or sputum, but is not visualized by imaging or bronchoscopy. |
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T0 | There is no evidence of primary tumor. |
Tis | Carcinoma in situ |
T1 | The tumor has the following characteristics:
|
T2 | The tumor has the following characteristics:
|
T3 | Tumor > 5 cm, but ≤ 7 cm in size.
AND It directly invades any of the following: chest wall (including superior sulcus tumors), diaphragm, mediastinal pleura, parietal pericardium. |
T4 | Tumor > 7 cm in size.
The tumor invades any of the following: mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina |
N:Regional Lymph Nodes
T | Description |
NX | The regional lymph nodes cannot be assessed. |
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N0 | There is no evidence of regional lymph node metastasis. |
N1 | Metastasis in ipsilateral peribronchial and/or ipsilateral hilum or intrapulmonary lymph nodes
N1a: A lymph node invasion. N1b: > 1 lymph node affected. |
N2 | There is metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s).
N2a1: One lymph node infested without lymph node involvement of an N1-defined lymph node station. N2a2: One lymph node infested with a lymph node of an N1-defined lymph node station N2b: > 1 lymph node affected |
N3 | There is metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s). |
M: Distant Metastasis
T | Description |
MX | Distant metastasis cannot be assessed. |
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M0 | There is no evidence of distant metastasis. |
M1 | There is evidence of distant metastasis which includes the presence of separate tumor nodule(s) in a different lobe (ipsilateral or contralateral).
M1a: Tumor foci separated from the primary tumor in a contralateral lung lobe; Tumor with pleural metastases or malignant pleural or pericardial effusion M1b: Simple metastases in an organ M1c: Multiple metastases in one organ or one or more metastases in more than one organ |
Classification of Lung Cancer by Staging
Stage | T | N | M |
Occult carcinoma | TX | N0 | M0 |
Stage 0 | Tis | N0 | M0 |
Stage IA1 | T1(mi)/T1a | N0 | M0 |
Stage IA2 | T1b | N0 | M0 |
Stage IA3 | T1c | N0 | M0 |
Stage IB | T2a | N0 | M0 |
Stage IIA | T2b | N0 | M0 |
Stage IIB | T1a | N1 | M0 |
T1c | N1 | M0 | |
T2a | N1 | M0 | |
T2b | N1 | M0 | |
T3 | N0 | M0 | |
Stage IIIA | T1a | N2 | M0 |
T1b | N2 | M0 | |
T1c | N2 | M0 | |
T2a | N2 | M0 | |
T2b | N2 | M0 | |
T1a | N2 | M0 | |
T1b | N2 | M0 | |
T1c | N2 | M0 | |
T2a | N2 | M0 | |
T2b | N2 | M0 | |
T3 | N1 | M0 | |
T4 | N0 | M0 | |
T4 | N1 | M0 | |
Stage IIIB | T1a | N3 | M0 |
T1b | N3 | M0 | |
T1c | N3 | M0 | |
T2a | N3 | M0 | |
T2b | N3 | M0 | |
T1a | N3 | M0 | |
T1b | N3 | M0 | |
T1c | N3 | M0 | |
T2a | N3 | M0 | |
T2b | N3 | M0 | |
T3 | N2 | M0 | |
T4 | N2 | M0 | |
Stage IIIC | T3 | N3 | M0 |
T4 | N3 | M0 | |
Stage IVA | Any T | Any N | M1a |
Any T | Any N | M1b | |
Stage IVB | Any T | Any N | M1c |
Biopsy
- Common types of lung tissue biopsy, include:[10]
- Needle biopsy
- Open biopsy
- Video-assisted thoracoscopic surgery (VATS)
- Indications for lung tissue biopsy in squamous cell carcinoma of the lung, include:[11]
- Determination of tumor histologic subtype
- Characterization of genetic mutations
- Determination of intra or extra-thoracic metastatic disease
- The table below summarizes the squamous cell carcinoma of the lung biopsy findings.[11]
Type of tumor | Biopsy findings |
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Squamous cell lung carcinoma |
|
References
- ↑ Rosado-de-Christenson ML, Templeton PA, Moran CA (1994). "Bronchogenic carcinoma: radiologic-pathologic correlation". Radiographics. 14 (2): 429–46, quiz 447–8. doi:10.1148/radiographics.14.2.8190965. PMID 8190965.
- ↑ 2.0 2.1 Parker MS, Chasen MH, Paul N (2009). "Radiologic signs in thoracic imaging: case-based review and self-assessment module". AJR Am J Roentgenol. 192 (3 Suppl): S34–48. doi:10.2214/AJR.07.7081. PMID 19234288.
- ↑ Kundel HL (1981). "Predictive value and threshold detectability of lung tumors". Radiology. 139 (1): 25–9. doi:10.1148/radiology.139.1.7208937. PMID 7208937.
- ↑ href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/29297">rID: 29297
- ↑ href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/29002">rID: 29002
- ↑ href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/27915">rID: 27915
- ↑ Mountain, CF (2003). A Handbook for Staging, Imaging, and Lymph Node Classification. Charles P Young Company. Retrieved 2007-09-01. Unknown parameter
|coauthors=
ignored (help) - ↑ Collins, LG (Jan 2007). "Lung cancer: diagnosis and management". American Family Physician. American Academy of Family Physicians. 75 (1): 56–63. PMID 17225705. Retrieved 2007-08-10. Unknown parameter
|coauthors=
ignored (help) - ↑ Harms, A.; Kriegsmann, M.; Fink, L.; Länger, F.; Warth, A. (2017). "Die neue TNM-Klassifikation für Lungentumoren". Der Pathologe. 38 (1): 11–20. doi:10.1007/s00292-017-0268-y. ISSN 0172-8113.
- ↑ Yung RC (2003). "Tissue diagnosis of suspected lung cancer: selecting between bronchoscopy, transthoracic needle aspiration, and resectional biopsy". Respir Care Clin N Am. 9 (1): 51–76. PMID 12820712.
- ↑ 11.0 11.1 Squamous cell carcinoma of the lung. Libre Pathology http://librepathology.org/wiki/Squamous_cell_carcinoma_of_the_lung Accessed on March 1, 2016