Lung cancer 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]Kim-Son H. Nguyen M.D., Cafer Zorkun, M.D., Ph.D. [3]. Rim Halaby, M.D. [4], Michael Maddaleni, B.S.
Overview
Chest CT scan is the modality of choice in the diagnosis of lung cancer. Findings on CT scan suggestive of lung cancer include a solitary pulmonary nodule, centrally located masses, mediastinal invasion CT scans help stage the lung cancer. A CT scan of the abdomen and brain can help visualize the common sights of metastases such as adrenal glands, liver, and brain. CT scans diagnose lung cancer by providing anatomical detail to locate the tumor, demonstrating proximity to the nearby structures, and deciphering whether lymph nodes are enlarged in the mediastinum.
Diagnostic Study of Choice
Study of Choice
Chest CT scan is the modality of choice in the diagnosis of lung cancer. Findings on CT scan suggestive of lung cancer include:[1]
- Solitary pulmonary nodule
- Centrally located masses
- Mediastinal invasion
- Peripherally situated lesions invading the chest wall
- A ground-glass opacity
- Consolidation
- Mixed density or pure ground glass nodules
- Mixed density or pure ground glass consolidation
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Spiral CT perfusion imaging
- Spiral CT perfusion study can be used as a diagnostic method for peripheral pulmonary nodules.
- Spiral CT perfusion study provides non-invasive method of quantitative assessment about the blood flow patterns of peripheral pulmonary nodules.
- Spiral CT perfusion imaging is analyzed and evaluated for:.[2]]]
- TDC (time density curve)
- Perfusion parametric maps
- The respective perfusion parameters.
- Immunohistochemical findings of microvessel density (MVD) measurement
- VEGF expression
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CT Findings of Metastatic disease
- CT scans help stage the lung cancer. A CT scan of the abdomen and brain can help visualize the common sights of metastases: adrenal glands, liver, and brain.
- The benefits of CT Scans in lung cancer patients are the following:[3]
- Provides anatomical detail to locate the tumor
- Demonstrates proximity to nearby structures
- Deciphers whether lymph nodes are enlarged in the mediastinum
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- Unfortunately, research has shown that there are a number of false positives associated with CT scanning because a CT scan on its own cannot determine malignancy.
- A positive result for a tumor using a CT scan is typically followed up with a biopsy for confirmation.
Staging
The following is 2017 TNM classification of lung cancer.[4][5][6]
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. |
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. |
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. |
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 |
Procedures for Staging Lung Cancer
There are currently multiple different procedures available to stage lung cancer.
- They can be broken down into two overarching categories, invasive and minimally invasive.
- The invasive procedures are:
- EUS-NA (esophageal endoscopic ultrasound with needle aspiration)
- TBNA (transbronchial needle aspiration)
- EBUS-NA (endobronchial ultrasound with needle aspiration)
- TTNA (transthoracic needle aspiration)
- VATS staging (video assisted thoracic surgery) aka thoracoscopy
- Extended cervical mediastinoscopy
- Chamberlain procedure
- The minimally invasive procedures are:
- The invasive procedures are:
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 Purandare, NilenduC; Rangarajan, Venkatesh (2015). "Imaging of lung cancer: Implications on staging and management". Indian Journal of Radiology and Imaging. 25 (2): 109. doi:10.4103/0971-3026.155831. ISSN 0971-3026.
- ↑ 2.0 2.1 2.2 Ma, Shu-Hua; Le, Hong-Bo; Jia, Bao-hui; Wang, Zhao-Xin; Xiao, Zhuang-Wei; Cheng, Xiao-Ling; Mei, Wei; Wu, Min; Hu, Zhi-Guo; Li, Yu-Guang (2008). "Peripheral pulmonary nodules: Relationship between multi-slice spiral CT perfusion imaging and tumor angiogenesis and VEGF expression". BMC Cancer. 8 (1). doi:10.1186/1471-2407-8-186. ISSN 1471-2407.
- ↑ Gerard A. Silvestri, Lynn T. Tanoue, Mitchell L. Margolis, John Barker, Frank Detterbeck.11/30/11.The Noninvasive Staging of Non Small-cell Lung Cancer. Chestpubs. http://chestjournal.chestpubs.org/content/123/1_suppl/147S.full/
- ↑ 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.