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==Overview== | ==Overview== | ||
Lung [[biopsy]] is the gold standard test for diagnosis of lung mass. However, in order to determine the extent of | Lung [[biopsy]] is the [[Gold standard (test)|gold standard test]] for the [[diagnosis]] of lung mass. However, in order to determine the extent of invasion and to derive [[therapy]], other investigative modalities such as [[CT scan]], [[sputum]] [[Cell biology|cytology]] and [[PET scan]] are also necessary. According to the [[American Joint Committee on Cancer|American Joint Committee on Cancer (AJCC)]] [[Cancer staging|staging]] system, there are 4 [[Cancer staging|stages]] of [[malignant]] lung mass based on 3 factors: [[tumor]] size, [[lymph node]] [[Invasive (medical)|invasion]], and [[metastasis]]. Each [[Cancer staging|stage]] is assigned a letter and a number that designate T for [[tumor]] size, N for [[Lymph node|node]] [[Invasive (medical)|invasion]], and M for [[metastasis]]. | ||
==Diagnostic Study of Choice== | ==Diagnostic Study of Choice== | ||
=== 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 [[biopsy]] is the [[Gold standard (test)|gold standard test]] for the [[diagnosis]] of lung mass. However, in order to determine the extent of invasion and to derive [[therapy]], other investigative modalities 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> | |||
*A multidisciplinary approach is required to correctly identify the sub-type of lung mass and its [[Cancer staging|staging]]. | *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. | *In general, [[diagnosis]] of lung mass is supplemented by the presence of [[clinical]], [[radiological]] and [[pathological]] evidence. | ||
* | *The mode of taking [[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 [[Patient|patients]] already undergoing [[surgery]] for a secondary condition. | ||
{{Lung mass}} | {{Lung mass}} | ||
===Staging=== | ===Staging=== | ||
The following table depicts the TNM classification | The following table depicts the [[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" style="text-align:center;font-size:90%;margin-left:1em;background:#E5AFAA;" | {| class="wikitable" style="text-align:center;font-size:90%;margin-left:1em;background:#E5AFAA;" | ||
|+ | |+ | ||
|- | |- | ||
| | | | ||
| Line 28: | Line 30: | ||
! colspan="3" |T: Primary tumor | ! colspan="3" |T: Primary tumor | ||
|- | |- | ||
! rowspan="2" |TX | |||
| rowspan="2" |Any of: | | rowspan="2" |Any of: | ||
|Primary tumor cannot be assessed | |[[Primary tumor]] cannot be assessed | ||
|- | |- | ||
|Tumor cells present in sputum or bronchial washing, but tumor not seen | |[[Tumor cell|Tumor cells]] present in [[sputum]] or [[bronchial]] washing, but [[tumor]] not seen on [[imaging]] or [[bronchoscopy]] | ||
|- | |- | ||
!T0 | |||
| colspan="2" |No evidence of primary tumor | | colspan="2" |No evidence of [[primary tumor]] | ||
|- | |- | ||
!Tis | |||
| colspan="2" |[[Carcinoma in situ]] | | 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 | | colspan="2" |[[Tumor]] size less than or equal to 3 cm across, surrounded by [[lung]] or [[visceral pleura]], without [[Invasive (medical)|invasion]] [[Anatomical terms of location|proximal]] to the [[Lobe (anatomy)|lobar]] [[bronchus]] | ||
|- | |- | ||
!T1a | |||
| colspan="2" |Tumor size less than or equal to 2 cm across | | 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 | | colspan="2" |[[Tumor]] size more than 2 cm but less than or equal to 3 cm across | ||
|- | |- | ||
! rowspan="4" |T2 | |||
| rowspan="4" |Any of: | | rowspan="4" |Any of: | ||
|Tumor size more than 3 cm but less than or equal to 7 cm across | |[[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 | |Involvement of the [[main bronchus]] at least 2 cm [[Anatomical terms of location|distal]] to the [[Carina of trachea|carina]] | ||
|- | |- | ||
|Invasion of visceral pleura | |Invasion of [[visceral pleura]] | ||
|- | |- | ||
|Atelectasis/obstructive pneumonitis extending to the hilum but not involving the whole lung | |[[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 | | 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 | | colspan="2" |[[Tumor]] size more than 5 cm but less than or equal to 7 cm across | ||
|- | |- | ||
! rowspan="5" |T3 | |||
| rowspan="5" |Any of: | | rowspan="5" |Any of: | ||
|Tumor size more than 7 cm across | |[[Tumor]] size more than 7 cm across | ||
|- | |- | ||
|Invasion into the chest wall, diaphragm, [[phrenic nerve]], mediastinal pleura or | |[[Invasive (medical)|Invasion]] into the [[chest wall]], [[Diaphragm (anatomy)|diaphragm]], [[phrenic nerve]], [[mediastinal pleura]] or [[parietal pericardium]] | ||
|- | |- | ||
|Tumor less than 2 cm distal to the carina, but not involving the carina | |[[Tumor]] less than 2 cm [[Anatomical terms of location|distal]] to the [[Carina of trachea|carina]], but not involving the [[Carina of trachea|carina]] | ||
|- | |- | ||
|Atelectasis/obstructive pneumonitis of the whole lung | |[[Atelectasis]]/obstructive [[pneumonitis]] of the whole [[lung]] | ||
|- | |- | ||
|Separate tumor nodule in the same lobe | |Separate [[tumor]] [[Nodule (medicine)|nodule]] in the same [[Lobe (anatomy)|lobe]] | ||
|- | |- | ||
! rowspan="2" |T4 | |||
| rowspan="2" |Any of: | | rowspan="2" |Any of: | ||
|Invasion of the mediastinum, heart, great vessels, trachea, carina, recurrent laryngeal nerve, esophagus, or vertebra | |[[Invasive (medical)|Invasion]] of the [[mediastinum]], [[heart]], [[great vessels]], [[trachea]], [[Carina of trachea|carina]], [[recurrent laryngeal nerve]], [[esophagus]], or [[vertebra]] | ||
|- | |- | ||
|Separate tumor nodule in a different lobe of the same lung | |Separate [[tumor]] [[Nodule (medicine)|nodule]] in a different [[Lobe (anatomy)|lobe]] of the same [[lung]] | ||
|} | |} | ||
| style="vertical-align:top;" | | | style="vertical-align:top;" | | ||
| Line 88: | Line 90: | ||
! colspan="3" |N: Lymph nodes | ! colspan="3" |N: Lymph nodes | ||
|- | |- | ||
!NX | |||
| colspan="2" |Regional lymph nodes cannot be assessed | | colspan="2" |Regional [[Lymph node|lymph nodes]] cannot be assessed | ||
|- | |- | ||
!N0 | |||
| colspan="2" |No regional lymph node metastasis | | colspan="2" |No regional [[lymph node]] [[metastasis]] | ||
|- | |- | ||
!N1 | |||
| colspan="2" |Metastasis to ipsilateral peribronchial and/or hilar lymph nodes | | colspan="2" |[[Metastasis]] to [[Anatomical terms of location|ipsilateral]] peribronchial and/or [[Hilum|hilar]] [[Lymph node|lymph nodes]] | ||
|- | |- | ||
!N2 | |||
| colspan="2" |Metastasis to ipsilateral mediastinal and/or | | colspan="2" |[[Metastasis]] to [[Anatomical terms of location|ipsilateral]] [[Mediastinum|mediastinal]] and/or sub-[[Carina of trachea|carinal]] [[Lymph node|lymph nodes]] | ||
|- | |- | ||
! rowspan="2" |N3 | |||
| rowspan="2" |Any of: | | rowspan="2" |Any of: | ||
|Metastasis to scalene or supraclavicular lymph nodes | |[[Metastasis]] to [[scalene]] or [[supraclavicular lymph nodes]] | ||
|- | |- | ||
|Metastasis to contralateral hilar or mediastinal lymph nodes | |[[Metastasis]] to [[Anatomical terms of location|contralateral]] [[Hilum|hilar]] or [[mediastinal lymph nodes]] | ||
|} | |} | ||
| style="vertical-align:top;" | | | style="vertical-align:top;" | | ||
| Line 111: | Line 113: | ||
! colspan="3" |M: Metastasis | ! colspan="3" |M: Metastasis | ||
|- | |- | ||
!MX | |||
| colspan="2" |Distant metastasis cannot be assessed | | colspan="2" |Distant [[metastasis]] cannot be assessed | ||
|- | |- | ||
!M0 | |||
| colspan="2" |No distant metastasis | | colspan="2" |No distant [[metastasis]] | ||
|- | |- | ||
! rowspan="3" |M1a | |||
| rowspan="3" |Any of: | | rowspan="3" |Any of: | ||
|Separate tumor nodule in the other lung | |Separate [[tumor]] [[Nodule (medicine)|nodule]] in the other [[lung]] | ||
|- | |- | ||
|Tumor with pleural nodules | |[[Tumor]] with [[pleural]] [[Nodule (medicine)|nodules]] | ||
|- | |- | ||
|Malignant pleural or pericardial effusion | |[[Malignant]] [[Pleural effusion|pleural]] or [[pericardial effusion]] | ||
|- | |- | ||
!M1b | |||
| colspan="2" |Distant metastasis | | colspan="2" |Distant [[metastasis]] | ||
|} | |} | ||
|} | |} | ||
Latest revision as of 16:58, 21 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 diagnostic study of choice On the Web |
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American Roentgen Ray Society Images of Lung mass diagnostic study of choice |
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Risk calculators and risk factors for Lung mass diagnostic study of choice |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]Maria Fernanda Villarreal, M.D. [3]
Overview
Lung biopsy is the gold standard test for the diagnosis of lung mass. However, in order to determine the extent of invasion and to derive therapy, other investigative modalities 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 invasion and to derive therapy, other investigative modalities 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.
- The mode of taking 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 diagnostic study of choice On the Web |
|
American Roentgen Ray Society Images of Lung mass diagnostic study of choice |
|
Risk calculators and risk factors for Lung mass diagnostic study of choice |
Staging
The following table depicts the TNM classification of lung cancer:[4]
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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.