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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

(A-D) Nodal disease. Right upper paratracheal nodes-N3 (arrow, 7A) in a left-sided lung cancer (block arrow, A). Pretracheal-N2 (arrow, B) and aortopulmonary-N3 (arrowhead, B) nodes in a right-sided lung cancer (block arrow, B). Left inferior pulmonary ligament node-N2 (arrow, C) in a left-sided lung cancer (block arrow, C). Right scalene node-N3 (arrow, D). (E-J) Nodal stations. Nodal stations based on the IASLC map (ref 15). Station 1 (E)- Low cervical, supraclavicular, and sternal notch; station 2 (E and F)- upper paratracheal; station 3a (F-H)- prevascular; station 3p (F-H)- retrotracheal; station 4 (H)- lower paratracheal; station 5 (G)- aortopulmonary window; station 6 (H)- para-aortic (ascending aorta or phrenic); station 7 (I)- subcarinal; station 8 (J)- paraesophageal (below carina); station 9 (J)- pulmonary ligament; station 10 (I)- hilar; stations 11-14 are not included in the figure
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Figure 7: (A-D) Nodal disease. Right upper paratracheal nodes-N3 (arrow, 7A) in a left-sided lung cancer (block arrow, A). Pretracheal-N2 (arrow, B) and aortopulmonary-N3 (arrowhead, B) nodes in a right-sided lung cancer (block arrow, B). Left inferior pulmonary ligament node-N2 (arrow, C) in a left-sided lung cancer (block arrow, C). Right scalene node-N3 (arrow, D). (E-J) Nodal stations. Nodal stations based on the IASLC map (ref 15). Station 1 (E)- Low cervical, supraclavicular, and sternal notch; station 2 (E and F)- upper paratracheal; station 3a (F-H)- prevascular; station 3p (F-H)- retrotracheal; station 4 (H)- lower paratracheal; station 5 (G)- aortopulmonary window; station 6 (H)- para-aortic (ascending aorta or phrenic); station 7 (I)- subcarinal; station 8 (J)- paraesophageal (below carina); station 9 (J)- pulmonary ligament; station 10 (I)- hilar; stations 11-14 are not included in the figure

Mentions: Accurate N staging is an important prognostic factor and is critical in deciding the best treatment option. Two systems for nodal mapping have been used over the years: One proposed by the American Thoracic Society (ATS) surgeons using the Mountain–Dressler system and other by Japanese surgeons using the Naruke classification.[1314] The use of two different systems leads to confusion and difficulty in performing statistical analysis for nodal disease. The IASLC has proposed a new system which has a unified and simplified approach to nodal mapping. The details for this new IASLC system of nodal maps can be accessed from the article by Lusch et al.[15] [Figure 7]. Nodes in the hilar, interlobar, lobar, segmental, and subsegmental regions are referred as N1 disease. Ipsilateral mediastinal nodes are considered as N2 disease and it includes nodes in the upper paratracheal, prevascular and retrotracheal, lower paratracheal, subcarinal, paraesophageal, and pulmonary ligament regions [Figure 7]. Involvement of ipsilateral or contralateral supraclavicular lymph nodes or extension to nodes in the contralateral mediastinal, hilar/interlobar, or peripheral zones is classified as N3 disease [Figure 7]. One of the important changes introduced in the new IASLC map is the shifting of boundary between the right and left sides of the mediastinum to the left lateral border of the trachea, instead of the midline division of the trachea proposed by the ATS. Unlike for T stage where there was subdivision and reclassification of T descriptors based on survival curves, the N descriptors have not changed in the current 7th edition as there was no overlap of survival curves and the survival progressively worsened with increasing N stage.[5]


Imaging of lung cancer: Implications on staging and management.

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

(A-D) Nodal disease. Right upper paratracheal nodes-N3 (arrow, 7A) in a left-sided lung cancer (block arrow, A). Pretracheal-N2 (arrow, B) and aortopulmonary-N3 (arrowhead, B) nodes in a right-sided lung cancer (block arrow, B). Left inferior pulmonary ligament node-N2 (arrow, C) in a left-sided lung cancer (block arrow, C). Right scalene node-N3 (arrow, D). (E-J) Nodal stations. Nodal stations based on the IASLC map (ref 15). Station 1 (E)- Low cervical, supraclavicular, and sternal notch; station 2 (E and F)- upper paratracheal; station 3a (F-H)- prevascular; station 3p (F-H)- retrotracheal; station 4 (H)- lower paratracheal; station 5 (G)- aortopulmonary window; station 6 (H)- para-aortic (ascending aorta or phrenic); station 7 (I)- subcarinal; station 8 (J)- paraesophageal (below carina); station 9 (J)- pulmonary ligament; station 10 (I)- hilar; stations 11-14 are not included in the figure
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Figure 7: (A-D) Nodal disease. Right upper paratracheal nodes-N3 (arrow, 7A) in a left-sided lung cancer (block arrow, A). Pretracheal-N2 (arrow, B) and aortopulmonary-N3 (arrowhead, B) nodes in a right-sided lung cancer (block arrow, B). Left inferior pulmonary ligament node-N2 (arrow, C) in a left-sided lung cancer (block arrow, C). Right scalene node-N3 (arrow, D). (E-J) Nodal stations. Nodal stations based on the IASLC map (ref 15). Station 1 (E)- Low cervical, supraclavicular, and sternal notch; station 2 (E and F)- upper paratracheal; station 3a (F-H)- prevascular; station 3p (F-H)- retrotracheal; station 4 (H)- lower paratracheal; station 5 (G)- aortopulmonary window; station 6 (H)- para-aortic (ascending aorta or phrenic); station 7 (I)- subcarinal; station 8 (J)- paraesophageal (below carina); station 9 (J)- pulmonary ligament; station 10 (I)- hilar; stations 11-14 are not included in the figure
Mentions: Accurate N staging is an important prognostic factor and is critical in deciding the best treatment option. Two systems for nodal mapping have been used over the years: One proposed by the American Thoracic Society (ATS) surgeons using the Mountain–Dressler system and other by Japanese surgeons using the Naruke classification.[1314] The use of two different systems leads to confusion and difficulty in performing statistical analysis for nodal disease. The IASLC has proposed a new system which has a unified and simplified approach to nodal mapping. The details for this new IASLC system of nodal maps can be accessed from the article by Lusch et al.[15] [Figure 7]. Nodes in the hilar, interlobar, lobar, segmental, and subsegmental regions are referred as N1 disease. Ipsilateral mediastinal nodes are considered as N2 disease and it includes nodes in the upper paratracheal, prevascular and retrotracheal, lower paratracheal, subcarinal, paraesophageal, and pulmonary ligament regions [Figure 7]. Involvement of ipsilateral or contralateral supraclavicular lymph nodes or extension to nodes in the contralateral mediastinal, hilar/interlobar, or peripheral zones is classified as N3 disease [Figure 7]. One of the important changes introduced in the new IASLC map is the shifting of boundary between the right and left sides of the mediastinum to the left lateral border of the trachea, instead of the midline division of the trachea proposed by the ATS. Unlike for T stage where there was subdivision and reclassification of T descriptors based on survival curves, the N descriptors have not changed in the current 7th edition as there was no overlap of survival curves and the survival progressively worsened with increasing N stage.[5]

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