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Imaging of lung cancer: Implications on staging and management.

Purandare NC, Rangarajan V - Indian J Radiol Imaging (2015 Apr-Jun)

Bottom Line: Lung cancer is one of the leading causes of cancer-related deaths.Accurate assessment of disease extent is important in deciding the optimal treatment approach.To play an important role in the multidisciplinary management of lung cancer patients, it is necessary that the radiologist understands the principles of staging and the implications of radiological findings on the various staging descriptors and eventual treatment decisions.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India.

ABSTRACT
Lung cancer is one of the leading causes of cancer-related deaths. Accurate assessment of disease extent is important in deciding the optimal treatment approach. To play an important role in the multidisciplinary management of lung cancer patients, it is necessary that the radiologist understands the principles of staging and the implications of radiological findings on the various staging descriptors and eventual treatment decisions.

No MeSH data available.


Related in: MedlinePlus

Common radiological appearances of lung cancer. Centrally located mass with mediastinal invasion (arrow, A), peripherally situated mass abutting the pleura (arrow, B), mass with smooth, lobulated margins (arrow, C) and with spiculated, irregular margins (arrow, D)
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Figure 1: Common radiological appearances of lung cancer. Centrally located mass with mediastinal invasion (arrow, A), peripherally situated mass abutting the pleura (arrow, B), mass with smooth, lobulated margins (arrow, C) and with spiculated, irregular margins (arrow, D)

Mentions: Majority of the lung cancer patients (approx 80%) are clinically symptomatic and present with cough, hemoptysis, dyspnea, chest pain, and non-resolving pneumonia.[3] Occasionally, they present with features suggestive of metastatic disease like skeletal pain or neurological symptoms and signs. Less than 10% of the patients are asymptomatic when the cancer is detected as an incidental finding.[3] Lung cancer is classified as either non-small cell lung cancer (NSCLC) or small cell lung cancer, with the NSCLC accounting for the vast majority (87%).[4] Chest radiograph is the first investigation which is performed while investigating a suspected case of lung cancer. Though it is a very good tool in providing preliminary information about the disease, it is inadequate for optimal characterization and staging. Computed Tomography (CT) scan of the chest is the cornerstone of lung cancer imaging based on which further management is decided. The primary tumor shows a wide spectrum of imaging appearances. NSCLCs can be centrally located masses, invading the mediastinal structures [Figure 1A], or peripherally situated lesions [Figure 1B] that invade the chest wall. Tumors can have margins which are smooth, lobulated [Figure 1C], or irregular and spiculated [Figure 1D]. They can be uniformly solid or can have central necrosis and cavitation [Figure 2A]. Centrally situated and cavitating tumors are more likely to be of squamous histology. Sometimes the tumor resembles an infective pathology and is seen as an area of consolidation [Figure 2B], a ground-glass opacity [Figure 2C, or a combination of both [Figure 2D]. Such an appearance is more commonly seen with adenocarcinoma and its subtypes. Mixed density or pure ground-glass nodules and consolidation with air bronchogram are seen in bronchoalveolar carcinomas, which are now referred to as adenocarcinoma in situ [Figure 2D]. Whatever the imaging appearance of the suspected lung cancer, obtaining tissue diagnosis by performing a bronchoscopic or an image-guided biopsy is necessary. When lung cancer is incidentally detected in an aymptomatic patient, it is often seen as a solitary pulmonary nodule (SPN) which can have varied imaging appearances. Imaging algorithm of SPN is a vast subject in itself and has not been included in this review.


Imaging of lung cancer: Implications on staging and management.

Purandare NC, Rangarajan V - Indian J Radiol Imaging (2015 Apr-Jun)

Common radiological appearances of lung cancer. Centrally located mass with mediastinal invasion (arrow, A), peripherally situated mass abutting the pleura (arrow, B), mass with smooth, lobulated margins (arrow, C) and with spiculated, irregular margins (arrow, D)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4419420&req=5

Figure 1: Common radiological appearances of lung cancer. Centrally located mass with mediastinal invasion (arrow, A), peripherally situated mass abutting the pleura (arrow, B), mass with smooth, lobulated margins (arrow, C) and with spiculated, irregular margins (arrow, D)
Mentions: Majority of the lung cancer patients (approx 80%) are clinically symptomatic and present with cough, hemoptysis, dyspnea, chest pain, and non-resolving pneumonia.[3] Occasionally, they present with features suggestive of metastatic disease like skeletal pain or neurological symptoms and signs. Less than 10% of the patients are asymptomatic when the cancer is detected as an incidental finding.[3] Lung cancer is classified as either non-small cell lung cancer (NSCLC) or small cell lung cancer, with the NSCLC accounting for the vast majority (87%).[4] Chest radiograph is the first investigation which is performed while investigating a suspected case of lung cancer. Though it is a very good tool in providing preliminary information about the disease, it is inadequate for optimal characterization and staging. Computed Tomography (CT) scan of the chest is the cornerstone of lung cancer imaging based on which further management is decided. The primary tumor shows a wide spectrum of imaging appearances. NSCLCs can be centrally located masses, invading the mediastinal structures [Figure 1A], or peripherally situated lesions [Figure 1B] that invade the chest wall. Tumors can have margins which are smooth, lobulated [Figure 1C], or irregular and spiculated [Figure 1D]. They can be uniformly solid or can have central necrosis and cavitation [Figure 2A]. Centrally situated and cavitating tumors are more likely to be of squamous histology. Sometimes the tumor resembles an infective pathology and is seen as an area of consolidation [Figure 2B], a ground-glass opacity [Figure 2C, or a combination of both [Figure 2D]. Such an appearance is more commonly seen with adenocarcinoma and its subtypes. Mixed density or pure ground-glass nodules and consolidation with air bronchogram are seen in bronchoalveolar carcinomas, which are now referred to as adenocarcinoma in situ [Figure 2D]. Whatever the imaging appearance of the suspected lung cancer, obtaining tissue diagnosis by performing a bronchoscopic or an image-guided biopsy is necessary. When lung cancer is incidentally detected in an aymptomatic patient, it is often seen as a solitary pulmonary nodule (SPN) which can have varied imaging appearances. Imaging algorithm of SPN is a vast subject in itself and has not been included in this review.

Bottom Line: Lung cancer is one of the leading causes of cancer-related deaths.Accurate assessment of disease extent is important in deciding the optimal treatment approach.To play an important role in the multidisciplinary management of lung cancer patients, it is necessary that the radiologist understands the principles of staging and the implications of radiological findings on the various staging descriptors and eventual treatment decisions.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India.

ABSTRACT
Lung cancer is one of the leading causes of cancer-related deaths. Accurate assessment of disease extent is important in deciding the optimal treatment approach. To play an important role in the multidisciplinary management of lung cancer patients, it is necessary that the radiologist understands the principles of staging and the implications of radiological findings on the various staging descriptors and eventual treatment decisions.

No MeSH data available.


Related in: MedlinePlus