Pancoast tumor diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mazia Fatima, MBBS [2]

Diagnostic Study of Choice

• CT scan is the gold standard test for the diagnosis of Pancoast tumor.
• The following result of CT scan is confirmatory of Pancoast tumor:
  • Opacity at the apex of the lung or in the superior sulcus area.
  • Spread of the tumor can result in rib invasion that is observed as bone destruction of posterior ribs.
  • Vertebral body infiltration
  • Enlargement of the mediastinum.
  • Invasion of brachial plexus
  • Invasion of chest wall and/or mediastinum
  • Extension of the tumor into vena cava, trachea and esophagus.
  • Subclavian vessel involvement is assessed by contrast CT scanning.

Irregular shaped ill defined right apical lung mass is seen invading the right aspect of D2 vertebral body with its transverse process, costovertebral junction and adjacent rib. superiorly it extends to the root of the neck.Case courtesy of Dr Ahmed Abd Rabou, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/27303">rID: 27303</a>

The chest CT scan confirms that the tumor involves the superior sulcus.Case courtesy of Dr David Cuete, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/23281">rID: 23281</a>

• MRI imaging should be performed for:
  • Evaluation of chest wall invasion
  • Examination of vascular structures and brachial plexus involvement
  • Evaluation of resectability of the tumor.

Diagnostic Criteria

• Pancoast tumor may be diagnosed at any time if one or more of the following criteria are met:
  • Criteria 1
  • Criteria 2
  • Criteria 3

References