Lung mass diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Lung mass}} | {{Lung mass}} | ||
{{CMG}};{{AE}} | {{CMG}};{{AE}}{{Akshun}} | ||
==Overview== | ==Overview== | ||
Lung [[biopsy]] is the gold standard test for diagnosis of lung mass. However, in order to determine the extent of lung mass and to derive therapy other tests such as [[CT scan]], sputum cytology and [[PET scan|PET]] scan are also necessary. According to the [[American Joint Committee on Cancer|American Joint Committee on Cancer (AJCC)]] staging system, there are 4 stages of malignant lung mass, based on 3 factors: tumor size, lymph node invasion, and metastasis. Each stage is assigned a letter and a number that designate T for tumor size, N for node invasion, and M for metastasis. | |||
==Diagnostic Study of Choice== | ==Diagnostic Study of Choice== | ||
Lung biopsy is the gold standard test for the diagnosis of lung mass. However, in order to determine the extent of lung mass and to derive therapy other tests are also necessary. | |||
*A multidisciplinary approach is required to correctly identify the sub-type of lung mass and its staging. | === Study of Choice === | ||
*In general, diagnosis of lung mass is supplemented by the presence of clinical, radiological and pathological evidence. | Lung [[biopsy]] is the gold standard test for the diagnosis of lung mass. However, in order to determine the extent of lung mass and to derive therapy other tests are also necessary.<ref>Kasper, Dennis L., et al. Harrison's principles of internal medicine. New York: McGraw Hill Education, 2015. Print</ref><ref name="pmid22391408">{{cite journal |vauthors=Frank L, Quint LE |title=Chest CT incidentalomas: thyroid lesions, enlarged mediastinal lymph nodes, and lung nodules |journal=Cancer Imaging |volume=12 |issue= |pages=41–8 |date=March 2012 |pmid=22391408 |pmc=3335330 |doi=10.1102/1470-7330.2012.0006 |url=}}</ref><ref name="pmid17225705">{{cite journal |vauthors=Collins LG, Haines C, Perkel R, Enck RE |title=Lung cancer: diagnosis and management |journal=Am Fam Physician |volume=75 |issue=1 |pages=56–63 |date=January 2007 |pmid=17225705 |doi= |url=}}</ref> | ||
*Mode of biopsy also depends upon the age and condition of patient. These include: | *A multidisciplinary approach is required to correctly identify the sub-type of lung mass and its [[Cancer staging|staging]]. | ||
*In general, diagnosis of lung mass is supplemented by the presence of [[clinical]], [[radiological]] and [[pathological]] evidence. | |||
*Mode of [[biopsy]] also depends upon the age and condition of patient. These include: | |||
**Ultrasound guided bronchial washings/brushings and aspiration. | **Ultrasound guided bronchial washings/brushings and aspiration. | ||
**Bronchoscopy or CT-guided biopsy. | **[[Bronchoscopy]] or [[CT]]-guided biopsy. | ||
**Unreachable lesions are evaluated with video-assisted thoracoscopic surgery. | **Unreachable lesions are evaluated with video-assisted thoracoscopic surgery. | ||
**Frozen sections in case of patients already undergoing surgery for a secondary condition. | **Frozen sections in case of patients already undergoing surgery for a secondary condition. | ||
{{Lung mass}} | |||
===Staging=== | |||
The following table depicts the TNM classification for lung cancer: | |||
{| class="wikitable" style="text-align:center;font-size:90%;margin-left:1em;background:#E5AFAA;" | |||
|+TNM classification of lung cancer <ref name="Harrison">{{Cite journal | last=Chheang | first=S |author2=Brown K | title=Lung cancer staging: clinical and radiologic perspectives | journal=Seminars in Interventional Radiology | volume=30 | issue=2 | pages=99–113 |date=June 2013 | pmid=24436525 | pmc=3709937 | doi=10.1055/s-0033-1342950}}</ref> | |||
|- | |||
| | |||
{| class="wikitable" | |||
|- | |||
! colspan="3" |T: Primary tumor | |||
|- | |||
| rowspan="2" |TX | |||
| rowspan="2" |Any of: | |||
|Primary tumor cannot be assessed | |||
|- | |||
|Tumor cells present in sputum or bronchial washing, but tumor not seen with imaging or bronchoscopy | |||
|- | |||
|T0 | |||
| colspan="2" |No evidence of primary tumor | |||
|- | |||
|Tis | |||
| colspan="2" |[[Carcinoma in situ]] | |||
|- | |||
|T1 | |||
| colspan="2" |Tumor size less than or equal to 3 cm across, surrounded by lung or visceral pleura, without invasion proximal to the lobar bronchus | |||
|- | |||
|T1a | |||
| colspan="2" |Tumor size less than or equal to 2 cm across | |||
|- | |||
|T1b | |||
| colspan="2" |Tumor size more than 2 cm but less than or equal to 3 cm across | |||
|- | |||
| rowspan="4" |T2 | |||
| rowspan="4" |Any of: | |||
|Tumor size more than 3 cm but less than or equal to 7 cm across | |||
|- | |||
|Involvement of the main bronchus at least 2 cm distal to the carina | |||
|- | |||
|Invasion of visceral pleura | |||
|- | |||
|Atelectasis/obstructive pneumonitis extending to the hilum but not involving the whole lung | |||
|- | |||
|T2a | |||
| colspan="2" |Tumor size more than 3 cm but less than or equal to 5 cm across | |||
|- | |||
|T2b | |||
| colspan="2" |Tumor size more than 5 cm but less than or equal to 7 cm across | |||
|- | |||
| rowspan="5" |T3 | |||
| rowspan="5" |Any of: | |||
|Tumor size more than 7 cm across | |||
|- | |||
|Invasion into the chest wall, diaphragm, [[phrenic nerve]], mediastinal pleura or parietal [[pericardium]] | |||
|- | |||
|Tumor less than 2 cm distal to the carina, but not involving the carina | |||
|- | |||
|Atelectasis/obstructive pneumonitis of the whole lung | |||
|- | |||
|Separate tumor nodule in the same lobe | |||
|- | |||
| rowspan="2" |T4 | |||
| rowspan="2" |Any of: | |||
|Invasion of the mediastinum, heart, great vessels, trachea, carina, recurrent laryngeal nerve, esophagus, or vertebra | |||
|- | |||
|Separate tumor nodule in a different lobe of the same lung | |||
|} | |||
| style="vertical-align:top;" | | |||
{| class="wikitable" | |||
|- | |||
! colspan="3" |N: Lymph nodes | |||
|- | |||
|NX | |||
| colspan="2" |Regional lymph nodes cannot be assessed | |||
|- | |||
|N0 | |||
| colspan="2" |No regional lymph node metastasis | |||
|- | |||
|N1 | |||
| colspan="2" |Metastasis to ipsilateral peribronchial and/or hilar lymph nodes | |||
|- | |||
|N2 | |||
| colspan="2" |Metastasis to ipsilateral mediastinal and/or subcarinal lymph nodes | |||
|- | |||
| rowspan="2" |N3 | |||
| rowspan="2" |Any of: | |||
|Metastasis to scalene or supraclavicular lymph nodes | |||
|- | |||
|Metastasis to contralateral hilar or mediastinal lymph nodes | |||
|} | |||
| style="vertical-align:top;" | | |||
{| class="wikitable" | |||
|- | |||
! colspan="3" |M: Metastasis | |||
|- | |||
|MX | |||
| colspan="2" |Distant metastasis cannot be assessed | |||
|- | |||
|M0 | |||
| colspan="2" |No distant metastasis | |||
|- | |||
| rowspan="3" |M1a | |||
| rowspan="3" |Any of: | |||
|Separate tumor nodule in the other lung | |||
|- | |||
|Tumor with pleural nodules | |||
|- | |||
|Malignant pleural or pericardial effusion | |||
|- | |||
|M1b | |||
| colspan="2" |Distant metastasis | |||
|} | |||
|} | |||
==References== | |||
{{reflist|2}} | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 20:32, 18 June 2019
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Lung Mass Microchapters |
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Diagnosis |
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Treatment |
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Lung mass diagnosis On the Web |
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American Roentgen Ray Society Images of Lung mass diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]
Overview
Lung biopsy is the gold standard test for diagnosis of lung mass. However, in order to determine the extent of lung mass and to derive therapy other tests such as CT scan, sputum cytology and PET scan are also necessary. According to the American Joint Committee on Cancer (AJCC) staging system, there are 4 stages of malignant lung mass, based on 3 factors: tumor size, lymph node invasion, and metastasis. Each stage is assigned a letter and a number that designate T for tumor size, N for node invasion, and M for metastasis.
Diagnostic Study of Choice
Study of Choice
Lung biopsy is the gold standard test for the diagnosis of lung mass. However, in order to determine the extent of lung mass and to derive therapy other tests are also necessary.[1][2][3]
- A multidisciplinary approach is required to correctly identify the sub-type of lung mass and its staging.
- In general, diagnosis of lung mass is supplemented by the presence of clinical, radiological and pathological evidence.
- Mode of biopsy also depends upon the age and condition of patient. These include:
- Ultrasound guided bronchial washings/brushings and aspiration.
- Bronchoscopy or CT-guided biopsy.
- Unreachable lesions are evaluated with video-assisted thoracoscopic surgery.
- Frozen sections in case of patients already undergoing surgery for a secondary condition.
|
Lung Mass Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Lung mass diagnosis On the Web |
|
American Roentgen Ray Society Images of Lung mass diagnosis |
Staging
The following table depicts the TNM classification for lung cancer:
|
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Kasper, Dennis L., et al. Harrison's principles of internal medicine. New York: McGraw Hill Education, 2015. Print
- ↑ Frank L, Quint LE (March 2012). "Chest CT incidentalomas: thyroid lesions, enlarged mediastinal lymph nodes, and lung nodules". Cancer Imaging. 12: 41–8. doi:10.1102/1470-7330.2012.0006. PMC 3335330. PMID 22391408.
- ↑ Collins LG, Haines C, Perkel R, Enck RE (January 2007). "Lung cancer: diagnosis and management". Am Fam Physician. 75 (1): 56–63. PMID 17225705.
- ↑ Chheang, S; Brown K (June 2013). "Lung cancer staging: clinical and radiologic perspectives". Seminars in Interventional Radiology. 30 (2): 99–113. doi:10.1055/s-0033-1342950. PMC 3709937. PMID 24436525.