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oral boards > lung CA staging > Flashcards

lung CA staging Flashcards

1
Q

NSCLC

IIB

stage criteria

A

either T3 OR N1:
T3 N0
T1-2 N1

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2
Q

NSCLC

minimum stage:
either T3 OR N1

A

IIB

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3
Q

NSCLC

stage: T2b N0

A

IIA
(this is the ONLY IIA)

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4
Q

NSCLC

IIA

stage criteria

A

only T2b N0

T2b = >4-5cm

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5
Q

NSCLC

cutoff criteria between I & II

A

>T2a OR >N0
i.e. >4cm & N0 OR <5cm & N1

i.e. T2b+ or N1+ = at least II

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6
Q

NSCLC

cutoff criteria between II & III

A

T4 (>7cm) N0
T3 (>5cm) N1
any N2+

incl T4 N1

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7
Q

NSCLC

T2 non-size criteria

A

+VPI
invading main bronchus
atelectasis to hilum

(T2 = >3-5cm)

if + above, T2a v T2b still by <4cm v >4-5cm

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8
Q

NSCLC

IA v IB

differentiating stage criteria

A

T1 v T2(a)
i.e. >3cm
OR +VPI OR inv main bronchus OR atelectasis to hilum

T1 = up to 3cm v T2a = 3-4cm

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9
Q

NSCLC

T2 by size

A

>3-5cm

OR +VPI OR invading main bronchus OR atelectasis to hilum

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10
Q

NSCLC

For T size criteria, lower limit = inclusive?

A

NO

e.g. T1b is >1 - </=2 cm, i.e. up to 2cm

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11
Q

NSCLC

For T size criteria, upper limit = inclusive?

A

YES

e.g. T1c is >2 - </=3 cm, i.e. up to 3cm

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12
Q

NSCLC

minimum T stage invading visceral pleura (+VPI)

A

T2a

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13
Q

NSCLC

minimum T stage invading main bronchus

but not carina

A

T2a

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14
Q

NSCLC

minimum T stage with +atelectasis to hilum

A

T2a

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15
Q

NSCLC

T1a size

A

≤1cm

i.e. up to 1cm

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16
Q

NSCLC

≤1cm

i.e. up to 1cm

A

T1a size

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17
Q

NSCLC

T1b size

A

>1-2cm

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18
Q

NSCLC

>1-2cm

A

T1b size

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19
Q

NSCLC

T1c size

A

>2-3cm

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20
Q

NSCLC

>2-3cm

A

T1c size

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21
Q

NSCLC

T2a size

A

>3-4cm

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22
Q

NSCLC

>3-4cm

A

T2a size

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23
Q

NSCLC

T2b size

A

>4-5cm

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24
Q

NSCLC

>4-5cm

A

T2b size

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25
Q

NSCLC

T1 size

A

>0-3cm

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26
Q

NSCLC

>0-3cm

A

T1 size

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27
Q

NSCLC

T2 size

A

>3-5cm

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28
Q

NSCLC

>3-5cm

A

T2 size

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29
Q

NSCLC

T3 size

A

>5-7cm

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30
Q

NSCLC

>5-7cm

A

T3 size

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31
Q

NSCLC

T4 size

A

>7cm

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32
Q

NSCLC

>7cm

A

T4 size

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33
Q

NSCLC

minimum T stage invading chest wall

A

T3

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34
Q

NSCLC

minimum T stage invading pericardium

A

T3

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35
Q

NSCLC

minimum T stage invading phrenic nerve

A

T3

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36
Q

NSCLC

minimum T stage with satellite nodule(s) in same lobe

ipsilateral (obviously)

A

T3

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37
Q

NSCLC

minimum T stage invading mediastinum

A

T4

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38
Q

NSCLC

minimum T stage invading diaphragm

A

T4

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39
Q

NSCLC

minimum T stage invading heart

A

T4

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40
Q

NSCLC

minimum T stage invading great vessels

A

T4

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41
Q

NSCLC

minimum T stage invading RLN

A

T4

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42
Q

NSCLC

minimum T stage invading carina

A

T4

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43
Q

NSCLC

minimum T stage invading trachea

A

T4

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44
Q

NSCLC

minimum T stage invading spine/vertebral column

A

T4

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45
Q

NSCLC

minimum T stage invading esophagus

A

T4

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46
Q

NSCLC

minimum T stage with satellite nodule(s) in different lobe

still ipsilateral

A

T4

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47
Q

NSCLC

T3 non-size criteria

A

invasion of resectable ipsilateral structures (i.e. chest wall, pericardium, phrenic nerve, same lobe as 1*)

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48
Q

NSCLC

T4 non-size criteria

A

invasion of structures either un-resectable (i.e. heart, great vessels) OR only resectable with large/extended resxn (i.e. ipsilateral lung different lobe, mediastinum, diaphragm, RLN, carina, trachea, esophagus, spine)

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49
Q

NSCLC

N0

A

self-explanatory

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50
Q

NSCLC

N1

A

ipsilateral pulmonary/hilar LN
i.e. >/=10
can be multiple

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51
Q

NSCLC

N2

A

ipsilateral mediastinal LN
incl 7
can be multiple

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52
Q

NSCLC

N3

A

supraclavicular OR any contralateral LN

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53
Q

NSCLC

M0

A

self-explanatory

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54
Q

NSCLC

M1a

A

satellite nodule(s) in contralateral lung
pleural/pericard dissemination (effusion or nodules)

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55
Q

NSCLC

M1b

A

single extrathoracic metastasis

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56
Q

NSCLC

M1c

A

multiple extrathoracic metastases

does NOT have to be >1 site, i.e. multiple mets in SAME organ/site count

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57
Q

NSCLC

T stage of a superficial spreading tumor in central airways

A

T1a

“The uncommon superficial spreading tumour of any size with its invasive component limited to the bronchial wall, which may extend proximal to the main bronchus, is also classified as T1a.”

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58
Q

NSCLC

T stage of a superficial spreading tumor

A

T1a

“The uncommon superficial spreading tumour of any size with its invasive component limited to the bronchial wall, which may extend proximal to the main bronchus, is also classified as T1a.”

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59
Q

NSCLC

T stage of a lepidic tumor (max 3cm) with ≤5mm invasive component

A

T1mi

minimally invasive

“Solitary adenocarcinoma (≤3cm), with a predominantly lepidic pattern and ≤5mm invasion in greatest dimension in any one focus.”

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60
Q

NSCLC

T1mi

A

≤3cm total size (single)
lepidic
≤5mm invasive component

minimally invasive

“Solitary adenocarcinoma (≤3cm), with a predominantly lepidic pattern and ≤5mm invasion in greatest dimension in any one focus.”

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61
Q

NSCLC

Does direct invasion of primary tumor into LN count as +N?

A

YES

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62
Q

NSCLC

Does invasion of a +LN into another structure upstage T?

A

NO

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63
Q

NSCLC

IA

stage criteria

A

T1 N0

T1a/b/c = IA1/2/3

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64
Q

NSCLC

stage: T1 N0

A

IA

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65
Q

NSCLC

IB

stage criteria

A

T2aN0

includes T2a by non-size criteria

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66
Q

NSCLC

stage: T2aN0

including if T2a by non-size criteria

A

IB

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67
Q

NSCLC

IIIA

stage criteria

A

T4 N0
T3-4 N1
T1-2 N2

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68
Q

NSCLC

stage: T4 N0

A

IIIA

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69
Q

NSCLC

stage: T1-2 N2

A

IIIA

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70
Q

NSCLC

stage: T3-4 N1

A

IIIA

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71
Q

NSCLC

IIIB

stage criteria

A

T3-4 N2
T1-2 N3

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72
Q

NSCLC

stage: T3-4 N2

A

IIIB

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73
Q

NSCLC

stage: T1-2 N3

A

IIIB

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74
Q

NSCLC

IIIC

stage criteria

A

T3-4 N3

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75
Q

NSCLC

stage: T3-4 N3

A

IIIC

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76
Q

NSCLC

IVA

stage criteria

A

M1a OR M1b
(M1a = ipsilateral pleural, pericardial, contralateral lung;
M1b = single extrathoracic met)

regardless of T/N

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77
Q

NSCLC

stage: M1a

A

IVA
(M1a = ipsilateral pleural, pericardial, contralateral lung;
M1b = single extrathoracic met)

regardless of T/N

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78
Q

NSCLC

stage: M1b

A

IVA
(M1a = ipsilateral pleural, pericardial, contralateral lung;
M1b = single extrathoracic met)

regardless of T/N

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79
Q

NSCLC

IVB

stage criteria

A

M1c
(multiple extrathoracic mets)

regardless of T/N

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80
Q

NSCLC

stage: M1c

A

IVB
(M1c = multiple extrathoracic mets)

regardless of T/N

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81
Q

NSCLC

station 1 LNs
general/named area(s)

A

[low] cervical, supraclavicular, sternal notch

82
Q

NSCLC

station 1R/1L anatomic dividing line

A

midline trachea

83
Q

NSCLC

station 2 LNs
general/named area(s)

A

upper paratracheal
& pretracheal (to L border)

84
Q

NSCLC

station 2R/2L anatomic dividing line

A

L lateral border of trachea

85
Q

NSCLC

station 4R/4L anatomic dividing line

A

L lateral border of trachea

86
Q

NSCLC

station 3a/p LNs
general/named area(s)

A

pre-vascular & retrotracheal

pre-tracheal (anterior to trachea) LN are actually encompassed by 2R/4R

87
Q

NSCLC

station 3aR/3aL anatomic dividing line

A

midline trachea

88
Q

NSCLC

station 3pR/3pL anatomic dividing line

A

N/A

only 3a is divided into R/L

89
Q

NSCLC

station 4R/L LNs
general/named area(s)

A

lower paratracheal
& pretracheal

90
Q

NSCLC

station 5 LNs
general/named area(s)

A

subaortic / aortopulmonary (AP) window

lateral to ligamentum arteriosum

91
Q

NSCLC

station 6 LNs
general/named area(s)

A

para-aortic
/ asc Ao or phrenic

anterior & lateral to asc Ao & arch

92
Q

NSCLC

station 7 LNs
general/named area(s)

A

subcarinal

93
Q

NSCLC

station 8 LNs
general/named area(s)

A

para-esophageal

adjacent to wall of esophagus & to R&L of midline, excluding subcarinal

94
Q

NSCLC

station 9 LNs
general/named area(s)

A

(inferior) pulmonary ligament

within the ligament

95
Q

NSCLC

station 10 LNs
general/named area(s)

A

hilar

adjacent to mainstem bronchi & hilar vessels incl prox veins & main PA

96
Q

NSCLC

station 11 LNs
general/named area(s)

A

interlobar

between origin of lobar bronchi

97
Q

NSCLC

station 12 LNs
general/named area(s)

A

lobar

adjacent to lobar bronchi

98
Q

NSCLC

station 13 LNs
general/named area(s)

A

segmental

adjacent to segmental bronchi

99
Q

NSCLC

station 14 LNs
general/named area(s)

A

subsegmental

adjacent to subsegmental bronchi

100
Q

NSCLC

station 1R borders

A

R cervical, supraclav, sternal notch
- upper: lower border of cricoid cartilage
- lower: upper border of manumbrium in midline, upper border of clavicles laterally
- medial: midline trachea
- (lateral: neck?)

101
Q

NSCLC

station 1L borders

A

L cervical, supraclav, sternal notch
- upper: lower border of cricoid cartilage
- lower: upper border of manumbrium in midline, upper border of clavicles laterally
- medial: midline trachea
- (lateral: neck?)

102
Q

NSCLC

station 1R/L upper border

A
  • upper: lower border of cricoid cartilage
103
Q

NSCLC

station 1R/L lower border

A
  • lower: upper border of manumbrium in midline, upper border of clavicles laterally
104
Q

NSCLC

station 1R/L medial border

A
  • medial: midline trachea
105
Q

NSCLC

station 2R borders

A

R upper paratracheal
- upper: apex of R lung/pleural space laterally, upper border manubrium medially
- lower: lower border of (L?) innominate vein at intersection with (R border of?) trachea
- medial: L border of trachea
- (lateral: pleura?)

106
Q

NSCLC

station 2R lower border

A
  • lower: lower border of (L?) innominate vein at intersection with (R border of?) trachea
107
Q

NSCLC

station 2R medial border

A
  • medial: L border of trachea
108
Q

NSCLC

station 2R/L upper border

A
  • upper: apex of R lung/pleural space laterally, upper border manubrium medially
109
Q

NSCLC

station 2L borders

A

L upper paratracheal
- upper: apex of L lung/pleural space laterally, upper border manubrium medially
- lower: upper border Ao arch
- medial: L border of trachea
- (lateral: pleura?)

110
Q

NSCLC

station 2L lower border

A
  • lower: upper border Ao arch
111
Q

NSCLC

station 2L medial border

A
  • medial: L border of trachea
112
Q

NSCLC

station 3a borders

A

prevascular
- upper: chest apex
- lower: level of carina
- anterior: posterior border of sternum
- posterior: anterior border of SVC on R, (anterior border of?) L (common?) carotid artery on L
- (lateral: pleura?)

113
Q

NSCLC

station 3a/p upper border

A

prevascular & retrotracheal
- upper: chest apex

114
Q

NSCLC

station 3a/p lower border

A

prevascular & retrotracheal
- lower: level of carina

115
Q

NSCLC

station 3a anterior border

A

prevascular
- anterior: posterior border of sternum

116
Q

NSCLC

station 3a posterior border

A

prevascular
- posterior: anterior border of SVC on R, (anterior border of?) L (common?) carotid artery on L

117
Q

NSCLC

station 3aR posterior border

A

prevascular
- posterior: anterior border of SVC on R

118
Q

NSCLC

station 3aL posterior border

A

prevascular
- posterior: (anterior border of?) L (common?) carotid artery on L

119
Q

NSCLC

station 3p borders

A

retrotracheal
- upper: chest apex
- lower: level of carina
- (anterior: posterior border of trachea?)
- (posterior: anterior border of spine?)
- (lateral: medial border of azygos vein on R, medial border of desc Ao on L?)

120
Q

NSCLC

station 3p anterior border

A

retrotracheal
- (anterior: posterior border of trachea?)

121
Q

NSCLC

station 3p posterior border

A

retrotracheal
- (posterior: anterior border of spine?)

122
Q

NSCLC

station 3p lateral border

A

retrotracheal
- (lateral: medial border of azygos vein on R, medial border of desc Ao on L?)

123
Q

NSCLC

station 4R borders

A

R lower paratracheal & pretracheal
- upper: lower border of innominate vein at intersection with trachea
- lower: lower border of azygos vein
- medial: L border of trachea
- (lateral: pleura?)

includes R pretracheal

  • IASLC LN map axial #2: https://drive.google.com/file/d/1qDaFkzIttMHwhcQ0acRARDx8Kn5OLH7O/view
  • IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
124
Q

NSCLC

station 4R upper border

A

R lower paratracheal & pretracheal
- upper: lower border of innominate vein at intersection with trachea

includes R pretracheal

  • IASLC LN map axial #2: https://drive.google.com/file/d/1qDaFkzIttMHwhcQ0acRARDx8Kn5OLH7O/view
  • IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
125
Q

NSCLC

station 4R lower border

A

R lower paratracheal & pretracheal
- lower: lower border of azygos vein

includes R pretracheal

  • IASLC LN map axial #2: https://drive.google.com/file/d/1qDaFkzIttMHwhcQ0acRARDx8Kn5OLH7O/view
  • IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
126
Q

NSCLC

station 4R medial border

A

R lower paratracheal & pretracheal
- medial: L border of trachea

includes R pretracheal

  • IASLC LN map axial #2: https://drive.google.com/file/d/1qDaFkzIttMHwhcQ0acRARDx8Kn5OLH7O/view
  • IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
127
Q

NSCLC

station 4L borders

A

L lower paratracheal
- upper: upper border of Ao arch
- lower: upper border of L PA
- medial: L border of trachea
- lateral: ligamentum arteriosum

= AP window medial to ligamentum (LA)

IASLC wording of 4L “upper margin of the aortic arch”, 2L “superior border of the aortic arch”, & 6 “line tangential to upper border of aortic arch” all mean same thing
- IASLC LN map axial #2: https://drive.google.com/file/d/1qDaFkzIttMHwhcQ0acRARDx8Kn5OLH7O/view
- IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
- The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 5: 4L/5 https://drive.google.com/file/d/1qnZd2O85wrx0tn3zaLxF_rZu_YDakXa-/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 6: 3a/6 https://drive.google.com/file/d/1qjnXnK_sf2SIJfwk92wkN4BMLFHB-23z/view

128
Q

NSCLC

station 4L upper border

A

L lower paratracheal
- upper: upper border of Ao arch

IASLC wording of 4L “upper margin of the aortic arch”, 2L “superior border of the aortic arch”, & 6 “line tangential to upper border of aortic arch” all mean same thing
- IASLC LN map axial #2: https://drive.google.com/file/d/1qDaFkzIttMHwhcQ0acRARDx8Kn5OLH7O/view
- IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
- The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 5: 4L/5 https://drive.google.com/file/d/1qnZd2O85wrx0tn3zaLxF_rZu_YDakXa-/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 6: 3a/6 https://drive.google.com/file/d/1qjnXnK_sf2SIJfwk92wkN4BMLFHB-23z/view

129
Q

NSCLC

station 4L lower border

A

L lower paratracheal
- lower: upper border of L PA

IASLC wording of 4L “upper margin of the aortic arch”, 2L “superior border of the aortic arch”, & 6 “line tangential to upper border of aortic arch” all mean same thing
- IASLC LN map axial #2: https://drive.google.com/file/d/1qDaFkzIttMHwhcQ0acRARDx8Kn5OLH7O/view
- IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
- The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 5: 4L/5 https://drive.google.com/file/d/1qnZd2O85wrx0tn3zaLxF_rZu_YDakXa-/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 6: 3a/6 https://drive.google.com/file/d/1qjnXnK_sf2SIJfwk92wkN4BMLFHB-23z/view

130
Q

NSCLC

station 4L medial border

A

L lower paratracheal
- medial: L border of trachea

IASLC wording of 4L “upper margin of the aortic arch”, 2L “superior border of the aortic arch”, & 6 “line tangential to upper border of aortic arch” all mean same thing
- IASLC LN map axial #2: https://drive.google.com/file/d/1qDaFkzIttMHwhcQ0acRARDx8Kn5OLH7O/view
- IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
- The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 5: 4L/5 https://drive.google.com/file/d/1qnZd2O85wrx0tn3zaLxF_rZu_YDakXa-/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 6: 3a/6 https://drive.google.com/file/d/1qjnXnK_sf2SIJfwk92wkN4BMLFHB-23z/view

131
Q

NSCLC

station 4L lateral border

A

L lower paratracheal
- lateral: ligamentum arteriosum

IASLC wording of 4L “upper margin of the aortic arch”, 2L “superior border of the aortic arch”, & 6 “line tangential to upper border of aortic arch” all mean same thing
- IASLC LN map axial #2: https://drive.google.com/file/d/1qDaFkzIttMHwhcQ0acRARDx8Kn5OLH7O/view
- IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
- The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 5: 4L/5 https://drive.google.com/file/d/1qnZd2O85wrx0tn3zaLxF_rZu_YDakXa-/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 6: 3a/6 https://drive.google.com/file/d/1qjnXnK_sf2SIJfwk92wkN4BMLFHB-23z/view

132
Q

NSCLC

station 5 borders

A

sub-aortic / PA window
- upper: lower border of Ao arch
- lower: upper border of L PA
- medial: ligamentum arteriosum
- (lateral: Ao arch/desc Ao?)

= AP window medial to LA; “subAo LN lateral to ligamentum arteriosum”

5 = lateral +/- inferior +/- anterior to 4L?
- IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
- IASLC LN map 5/6: https://drive.google.com/file/d/1puFW0BgRwhzvpCOQdE7fgN9okvpTJ_aY/view
- IASLC LN map sagittal L: https://drive.google.com/file/d/1q-xiI1OccvVczV7DyBdIw3cfD1LDtUSZ/view
- IASLC LN map axial #2: https://drive.google.com/file/d/1qDaFkzIttMHwhcQ0acRARDx8Kn5OLH7O/view
- The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 5: 4L/5 https://drive.google.com/file/d/1qnZd2O85wrx0tn3zaLxF_rZu_YDakXa-/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 6: 3a/6 https://drive.google.com/file/d/1qjnXnK_sf2SIJfwk92wkN4BMLFHB-23z/view

133
Q

NSCLC

station 5 upper border

A

sub-aortic / PA window
- upper: lower border of Ao arch

subaortic LN laterla to ligamentum arteriosum

5 = lateral +/- inferior +/- anterior to 4L?
- IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
- IASLC LN map 5/6: https://drive.google.com/file/d/1puFW0BgRwhzvpCOQdE7fgN9okvpTJ_aY/view
- IASLC LN map sagittal L: https://drive.google.com/file/d/1q-xiI1OccvVczV7DyBdIw3cfD1LDtUSZ/view
- IASLC LN map axial #2: https://drive.google.com/file/d/1qDaFkzIttMHwhcQ0acRARDx8Kn5OLH7O/view
- The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 5: 4L/5 https://drive.google.com/file/d/1qnZd2O85wrx0tn3zaLxF_rZu_YDakXa-/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 6: 3a/6 https://drive.google.com/file/d/1qjnXnK_sf2SIJfwk92wkN4BMLFHB-23z/view

134
Q

NSCLC

station 5 lower border

A

sub-aortic / PA window
- lower: upper border of L PA

subaortic LN laterla to ligamentum arteriosum

5 = lateral +/- inferior +/- anterior to 4L?
- IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
- IASLC LN map 5/6: https://drive.google.com/file/d/1puFW0BgRwhzvpCOQdE7fgN9okvpTJ_aY/view
- IASLC LN map sagittal L: https://drive.google.com/file/d/1q-xiI1OccvVczV7DyBdIw3cfD1LDtUSZ/view
- IASLC LN map axial #2: https://drive.google.com/file/d/1qDaFkzIttMHwhcQ0acRARDx8Kn5OLH7O/view
- The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 5: 4L/5 https://drive.google.com/file/d/1qnZd2O85wrx0tn3zaLxF_rZu_YDakXa-/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 6: 3a/6 https://drive.google.com/file/d/1qjnXnK_sf2SIJfwk92wkN4BMLFHB-23z/view

135
Q

NSCLC

station 5 medial border

A

sub-aortic / PA window
- medial: ligamentum arteriosum

subaortic LN laterla to ligamentum arteriosum

5 = lateral +/- inferior +/- anterior to 4L?
- IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
- IASLC LN map 5/6: https://drive.google.com/file/d/1puFW0BgRwhzvpCOQdE7fgN9okvpTJ_aY/view
- IASLC LN map sagittal L: https://drive.google.com/file/d/1q-xiI1OccvVczV7DyBdIw3cfD1LDtUSZ/view
- IASLC LN map axial #2: https://drive.google.com/file/d/1qDaFkzIttMHwhcQ0acRARDx8Kn5OLH7O/view
- The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 5: 4L/5 https://drive.google.com/file/d/1qnZd2O85wrx0tn3zaLxF_rZu_YDakXa-/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 6: 3a/6 https://drive.google.com/file/d/1qjnXnK_sf2SIJfwk92wkN4BMLFHB-23z/view

136
Q

NSCLC

station 6 borders

A

para-aortic / asc Ao / phrenic
- upper: upper border of Ao arch (line tangential to)
- lower: lower border of Ao arch
- (medial: Ao arch)
- (lateral: pleura?)
- (anterior: level of anterior-most border of Ao arch? not explicitly defined by IASLC)

anterior & lateral to asc Ao & arch

6 = anterior (& medial?) to 5? which is lateral +/- inferior +/- anterior to 4L?
- IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
- IASLC LN map 5/6: https://drive.google.com/file/d/1puFW0BgRwhzvpCOQdE7fgN9okvpTJ_aY/view
- IASLC LN map sagittal L: https://drive.google.com/file/d/1q-xiI1OccvVczV7DyBdIw3cfD1LDtUSZ/view
- IASLC LN map axial #2: https://drive.google.com/file/d/1qDaFkzIttMHwhcQ0acRARDx8Kn5OLH7O/view
- The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 5: 4L/5 https://drive.google.com/file/d/1qnZd2O85wrx0tn3zaLxF_rZu_YDakXa-/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 6: 3a/6 https://drive.google.com/file/d/1qjnXnK_sf2SIJfwk92wkN4BMLFHB-23z/view

137
Q

NSCLC

station 6 upper border

A

para-aortic / asc Ao / phrenic
- upper: upper border of Ao arch (line tangential to)

anterior & lateral to asc Ao & arch

6 = anterior (& medial?) to 5? which is lateral +/- inferior +/- anterior to 4L?
- IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
- IASLC LN map 5/6: https://drive.google.com/file/d/1puFW0BgRwhzvpCOQdE7fgN9okvpTJ_aY/view
- IASLC LN map sagittal L: https://drive.google.com/file/d/1q-xiI1OccvVczV7DyBdIw3cfD1LDtUSZ/view
- IASLC LN map axial #2: https://drive.google.com/file/d/1qDaFkzIttMHwhcQ0acRARDx8Kn5OLH7O/view
- The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 5: 4L/5 https://drive.google.com/file/d/1qnZd2O85wrx0tn3zaLxF_rZu_YDakXa-/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 6: 3a/6 https://drive.google.com/file/d/1qjnXnK_sf2SIJfwk92wkN4BMLFHB-23z/view

138
Q

NSCLC

station 6 lower border

A

para-aortic / asc Ao / phrenic
- lower: lower border of Ao arch

anterior & lateral to asc Ao & arch

6 = anterior (& medial?) to 5? which is lateral +/- inferior +/- anterior to 4L?
- IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
- IASLC LN map 5/6: https://drive.google.com/file/d/1puFW0BgRwhzvpCOQdE7fgN9okvpTJ_aY/view
- IASLC LN map sagittal L: https://drive.google.com/file/d/1q-xiI1OccvVczV7DyBdIw3cfD1LDtUSZ/view
- IASLC LN map axial #2: https://drive.google.com/file/d/1qDaFkzIttMHwhcQ0acRARDx8Kn5OLH7O/view
- The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 5: 4L/5 https://drive.google.com/file/d/1qnZd2O85wrx0tn3zaLxF_rZu_YDakXa-/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 6: 3a/6 https://drive.google.com/file/d/1qjnXnK_sf2SIJfwk92wkN4BMLFHB-23z/view

139
Q

NSCLC

station 6 medial border

A

para-aortic / asc Ao / phrenic
- (medial: Ao arch)

anterior & lateral to asc Ao & arch

6 = anterior (& medial?) to 5? which is lateral +/- inferior +/- anterior to 4L?
- IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
- IASLC LN map 5/6: https://drive.google.com/file/d/1puFW0BgRwhzvpCOQdE7fgN9okvpTJ_aY/view
- IASLC LN map sagittal L: https://drive.google.com/file/d/1q-xiI1OccvVczV7DyBdIw3cfD1LDtUSZ/view
- IASLC LN map axial #2: https://drive.google.com/file/d/1qDaFkzIttMHwhcQ0acRARDx8Kn5OLH7O/view
- The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 5: 4L/5 https://drive.google.com/file/d/1qnZd2O85wrx0tn3zaLxF_rZu_YDakXa-/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 6: 3a/6 https://drive.google.com/file/d/1qjnXnK_sf2SIJfwk92wkN4BMLFHB-23z/view

140
Q

NSCLC

station 7 borders

A

subcarinal
- upper: carina
- lower: lower border of BI on R, upper border of LLL bronchus on L
- (lateral: inner/medial border of bronchi)

IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view

141
Q

station 7 upper border

A

subcarinal
- upper: carina

IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view

142
Q

NSCLC

station 7 lower border

A

subcarinal
- lower: lower border of BI on R, upper border of LLL bronchus on L

IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view

143
Q

NSCLC

station 7 lateral border

A

subcarinal
- (lateral: inner/medial border of bronchi)

IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view

144
Q

NSCLC

station 8 borders

A

para-esophageal
- upper: lower border of BI on R, upper border of LLL bronchus on L
- lower: diaphragm
- (lateral: pleura?)
- (medial: midline esophagus? undefined by IASLC)

“adjacent to esophagus wall & to R or L of midline, excl subcarinal LN”

essentially same medial space as 7 but below that?
- IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
- The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 8: 8/9 https://drive.google.com/file/d/1qaJotImbk7sbBSKqvaSGUzF1b-VuAAHP/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 9: 8/9/IPL https://drive.google.com/file/d/1qhNwoHt04hSAZilsY29sEM1iD_OI4obV/view

145
Q

NSCLC

station 8 upper border

A

para-esophageal
- upper: lower border of BI on R, upper border of LLL bronchus on L

“adjacent to esophagus wall & to R or L of midline, excl subcarinal LN”

essentially same medial space as 7 but below that?
- IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
- The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 8: 8/9 https://drive.google.com/file/d/1qaJotImbk7sbBSKqvaSGUzF1b-VuAAHP/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 9: 8/9/IPL https://drive.google.com/file/d/1qhNwoHt04hSAZilsY29sEM1iD_OI4obV/view

146
Q

NSCLC

station 8 lower border

A

para-esophageal
- lower: diaphragm

“adjacent to esophagus wall & to R or L of midline, excl subcarinal LN”

essentially same medial space as 7 but below that?
- IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
- The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 8: 8/9 https://drive.google.com/file/d/1qaJotImbk7sbBSKqvaSGUzF1b-VuAAHP/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 9: 8/9/IPL https://drive.google.com/file/d/1qhNwoHt04hSAZilsY29sEM1iD_OI4obV/view

147
Q

NSCLC

station 8R/8L anatomic dividing line

A

midline esophagus?
undefined by IASLC

“adjacent to esophagus wall & to R or L of midline, excl subcarinal LN”

essentially same medial space as 7 but below that?
- IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
- IASLC LN Map- Radiologic Review with CT Illustration (2014) - RSNA - Fig. 13: Station 8. Coronal reconstructed CT image shows the borders of station 8 (yellow area). The upper borders are the inferior-most margin of the bronchus intermedius on the right and the superior-most margin of the lower lobe bronchus on the left, and the lower border is the diaphragm. In our practices, the midline of the esophagus serves as the boundary between a right- and left-sided station 8 lymph node. https://drive.google.com/file/d/1qKvBOfj0-8FVUYTZ7wYTnvIwtvkkuuho/view
- The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 8: 8/9 https://drive.google.com/file/d/1qaJotImbk7sbBSKqvaSGUzF1b-VuAAHP/view
- IASLC LN Map: Radiologic Atlas & Review Fig. 9: 8/9/IPL https://drive.google.com/file/d/1qhNwoHt04hSAZilsY29sEM1iD_OI4obV/view

148
Q

NSCLC

station 9 borders

A

IPL / (inf) pulm ligament
- upper: lower border IPV
- lower: diaphragm
- (lateral/medial: borders of IPL?)

“lying within the pulmonary ligament”

  • The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
  • IASLC LN Map: Radiologic Atlas & Review Fig. 8: 8/9 https://drive.google.com/file/d/1qaJotImbk7sbBSKqvaSGUzF1b-VuAAHP/view
  • IASLC LN Map: Radiologic Atlas & Review Fig. 9: 8/9/IPL https://drive.google.com/file/d/1qhNwoHt04hSAZilsY29sEM1iD_OI4obV/view
149
Q

NSCLC

station 9 upper border

A

IPL / (inf) pulm ligament
- upper: lower border IPV

“lying within the pulmonary ligament”

  • The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
  • IASLC LN Map: Radiologic Atlas & Review Fig. 8: 8/9 https://drive.google.com/file/d/1qaJotImbk7sbBSKqvaSGUzF1b-VuAAHP/view
  • IASLC LN Map: Radiologic Atlas & Review Fig. 9: 8/9/IPL https://drive.google.com/file/d/1qhNwoHt04hSAZilsY29sEM1iD_OI4obV/view
150
Q

NSCLC

station 9 lower border

A

IPL / (inf) pulm ligament
- lower: diaphragm

“lying within the pulmonary ligament”

  • The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review (2015) https://drive.google.com/file/d/1qYg5Cf_RO8bZ4dW0QmqL24JQOdqHJTD0/view
  • IASLC LN Map: Radiologic Atlas & Review Fig. 8: 8/9 https://drive.google.com/file/d/1qaJotImbk7sbBSKqvaSGUzF1b-VuAAHP/view
  • IASLC LN Map: Radiologic Atlas & Review Fig. 9: 8/9/IPL https://drive.google.com/file/d/1qhNwoHt04hSAZilsY29sEM1iD_OI4obV/view
151
Q

NSCLC

station 10 borders

A

hilar
- upper: lower border of azygos vein on R, upper border of PA on L
- lower: “interlobar region bilaterally” = upper border of first lobar bronchus takeoff?
- (medial: bronchi/level 7?)
- (lateral: beyond adjacent to a mainstem bronchus – defined as “immediately adjacent to mainstem bronchus”)

“immed adjacent to mainstem bronchus & hilar vessels incl prox PV & mPA”

  • IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
  • IASLC LN map axial #3: https://drive.google.com/file/d/1qGruEDNW_h6Q2gxITgu8PMxgE5BDRDBz/view
  • IASLC LN Map- Radiologic Review with CT Illustration (2014) - RSNA - Fig. 14 https://drive.google.com/file/d/1qKvBOfj0-8FVUYTZ7wYTnvIwtvkkuuho/view
  • IASLC LN Map- Radiologic Review with CT Illustration (2014) - RSNA - Fig. 10: 4/10 https://drive.google.com/file/d/1qp3NrTRCAlBtXiqUc9kx5MaE9OyxOFz6/view
152
Q

NSCLC

station 10 upper border

A

hilar
- upper: lower border of azygos vein on R, upper border of PA on L

“immed adjacent to mainstem bronchus & hilar vessels incl prox PV & mPA”

  • IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
  • IASLC LN map axial #3: https://drive.google.com/file/d/1qGruEDNW_h6Q2gxITgu8PMxgE5BDRDBz/view
  • IASLC LN Map- Radiologic Review with CT Illustration (2014) - RSNA - Fig. 14 https://drive.google.com/file/d/1qKvBOfj0-8FVUYTZ7wYTnvIwtvkkuuho/view
  • IASLC LN Map- Radiologic Review with CT Illustration (2014) - RSNA - Fig. 10: 4/10 https://drive.google.com/file/d/1qp3NrTRCAlBtXiqUc9kx5MaE9OyxOFz6/view
153
Q

NSCLC

station 10 lower border

A

hilar
- lower: “interlobar region bilaterally” = upper border of first lobar bronchus takeoff?

“immed adjacent to mainstem bronchus & hilar vessels incl prox PV & mPA”

  • IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
  • IASLC LN map axial #3: https://drive.google.com/file/d/1qGruEDNW_h6Q2gxITgu8PMxgE5BDRDBz/view
  • IASLC LN Map- Radiologic Review with CT Illustration (2014) - RSNA - Fig. 14 https://drive.google.com/file/d/1qKvBOfj0-8FVUYTZ7wYTnvIwtvkkuuho/view
  • IASLC LN Map- Radiologic Review with CT Illustration (2014) - RSNA - Fig. 10: 4/10 https://drive.google.com/file/d/1qp3NrTRCAlBtXiqUc9kx5MaE9OyxOFz6/view
154
Q

NSCLC

station 11 borders

A

interlobar
N/A
not defined by borders, rather by r/t bronchi:
- 11Rs (superior) = bet/ RUL & BI
- 11Ri (inferior) = bet/ RML & RLL
- 11L = bet/ LUL & LLL

IASLC LN Map- Radiologic Review with CT Illustration (2014) - RSNA - Fig. 14: Stations 11R and 11L. Coronal reconstructed CT image shows the borders of stations 11R—which is subdivided into stations 11Rs and 11Ri—and 11L. Station 11Rs refers to lymph nodes located between the right upper lobe bronchus (RUL br) and the bronchus intermedius (BI), and station 11Ri denotes lymph nodes located between the right middle (RML br) and right lower (RLL br) lobe bronchi. Station 11L refers to lymph nodes located between the left upper lobe bronchus (LUL br) and the left lower lobe bronchus (LLL br). https://drive.google.com/file/d/1qKvBOfj0-8FVUYTZ7wYTnvIwtvkkuuho/view

155
Q

NSCLC

station 11Rs definition

A

interlobar
N/A
not defined by borders, rather by r/t bronchi:
- 11Rs (superior) = bet/ RUL & BI

IASLC LN Map- Radiologic Review with CT Illustration (2014) - RSNA - Fig. 14: Stations 11R and 11L. Coronal reconstructed CT image shows the borders of stations 11R—which is subdivided into stations 11Rs and 11Ri—and 11L. Station 11Rs refers to lymph nodes located between the right upper lobe bronchus (RUL br) and the bronchus intermedius (BI), and station 11Ri denotes lymph nodes located between the right middle (RML br) and right lower (RLL br) lobe bronchi. Station 11L refers to lymph nodes located between the left upper lobe bronchus (LUL br) and the left lower lobe bronchus (LLL br). https://drive.google.com/file/d/1qKvBOfj0-8FVUYTZ7wYTnvIwtvkkuuho/view

156
Q

NSCLC

station 11Ri definition

A

interlobar
N/A
not defined by borders, rather by r/t bronchi:
- 11Ri (inferior) = bet/ RML & RLL

IASLC LN Map- Radiologic Review with CT Illustration (2014) - RSNA - Fig. 14: Stations 11R and 11L. Coronal reconstructed CT image shows the borders of stations 11R—which is subdivided into stations 11Rs and 11Ri—and 11L. Station 11Rs refers to lymph nodes located between the right upper lobe bronchus (RUL br) and the bronchus intermedius (BI), and station 11Ri denotes lymph nodes located between the right middle (RML br) and right lower (RLL br) lobe bronchi. Station 11L refers to lymph nodes located between the left upper lobe bronchus (LUL br) and the left lower lobe bronchus (LLL br). https://drive.google.com/file/d/1qKvBOfj0-8FVUYTZ7wYTnvIwtvkkuuho/view

157
Q

NSCLC

station 11L definition

A

interlobar
N/A
not defined by borders, rather by r/t bronchi:
- 11L = bet/ LUL & LLL

IASLC LN Map- Radiologic Review with CT Illustration (2014) - RSNA - Fig. 14: Stations 11R and 11L. Coronal reconstructed CT image shows the borders of stations 11R—which is subdivided into stations 11Rs and 11Ri—and 11L. Station 11Rs refers to lymph nodes located between the right upper lobe bronchus (RUL br) and the bronchus intermedius (BI), and station 11Ri denotes lymph nodes located between the right middle (RML br) and right lower (RLL br) lobe bronchi. Station 11L refers to lymph nodes located between the left upper lobe bronchus (LUL br) and the left lower lobe bronchus (LLL br). https://drive.google.com/file/d/1qKvBOfj0-8FVUYTZ7wYTnvIwtvkkuuho/view

158
Q

NSCLC

zones of ambiguity in the IASLC LN map

A
  • 1 v 2/3 (d/t extension of lung/pleural apices above level of manubrium/clavicles)
  • pretracheal LN (d/t potential for space below 4R/L level, between 10R/L level, and above 7/carina)

IASLC LN Map- Radiologic Review with CT Illustration (2014) - RSNA https://drive.google.com/file/d/1qKvBOfj0-8FVUYTZ7wYTnvIwtvkkuuho/view

159
Q

NSCLC

station 12 borders

A

lobar
N/A
not defined by borders, rather by r/t bronchi:
- adjacent to lobar bronchi (distal to bifurc)

160
Q

NSCLC

station 13 borders

A

segmental
N/A
not defined by borders, rather by r/t bronchi:
- adjacent to segmental bronchi

161
Q

NSCLC

station 14 borders

A

subsegmental
N/A
not defined by borders, rather by r/t bronchi:
- adjacent to subsegmental bronchi

162
Q

NSCLC LN station (#):

[low] cervical, supraclavicular, sternal notch

A

station 1 LNs

163
Q

NSCLC LN station (#):

upper paratracheal
& pretracheal

A

station 2 LNs

164
Q

NSCLC LN station (#):

pre-vascular & retrotracheal

A

station 3a/p LNs

pre-tracheal (anterior to trachea) LN are actually encompassed by 2R/4R

165
Q

NSCLC LN station (#):

lower paratracheal
& pretracheal

A

station 4R/L LNs

166
Q

NSCLC LN station (#):

subaortic / aortopulmonary (AP) window

lateral to ligamentum arteriosum

A

station 5 LNs

167
Q

NSCLC LN station (#):

para-aortic
/ asc Ao or phrenic

anterior & lateral to asc Ao & arch

A

station 6 LNs

168
Q

NSCLC LN station (#):

subcarinal

A

station 7 LNs

169
Q

NSCLC LN station (#):

para-esophageal

adjacent to wall of esophagus & to R&L of midline, excluding subcarinal

A

station 8 LNs

170
Q

NSCLC LN station (#):

(inferior) pulmonary ligament

within the ligament

A

station 9 LNs

171
Q

NSCLC LN station (#):

hilar

adjacent to mainstem bronchi & hilar vessels incl prox veins & main PA

A

station 10 LNs

172
Q

NSCLC LN station (#):

interlobar

between origin of lobar bronchi @ bronchial carina

A

station 11 LNs

173
Q

NSCLC LN station (#):

lobar

adjacent to lobar bronchi

A

station 12 LNs

174
Q

NSCLC LN station (#):

segmental

adjacent to segmental bronchi

A

station 13 LNs

175
Q

NSCLC LN station (#):

subsegmental

adjacent to subsegmental bronchi

A

station 14 LNs

176
Q

NSCLC LN station (#):

bet/ RUL & BI bronchi / @ RUL/BIcarina

A

station 11Rs

IASLC LN Map- Radiologic Review with CT Illustration (2014) - RSNA - Fig. 14: Stations 11R and 11L. Coronal reconstructed CT image shows the borders of stations 11R—which is subdivided into stations 11Rs and 11Ri—and 11L. Station 11Rs refers to lymph nodes located between the right upper lobe bronchus (RUL br) and the bronchus intermedius (BI), and station 11Ri denotes lymph nodes located between the right middle (RML br) and right lower (RLL br) lobe bronchi. Station 11L refers to lymph nodes located between the left upper lobe bronchus (LUL br) and the left lower lobe bronchus (LLL br). https://drive.google.com/file/d/1qKvBOfj0-8FVUYTZ7wYTnvIwtvkkuuho/view

177
Q

NSCLC LN station (#):

bet/ RML & RLL bronchi / @ RML/RLL carina

A

station 11Ri

IASLC LN Map- Radiologic Review with CT Illustration (2014) - RSNA - Fig. 14: Stations 11R and 11L. Coronal reconstructed CT image shows the borders of stations 11R—which is subdivided into stations 11Rs and 11Ri—and 11L. Station 11Rs refers to lymph nodes located between the right upper lobe bronchus (RUL br) and the bronchus intermedius (BI), and station 11Ri denotes lymph nodes located between the right middle (RML br) and right lower (RLL br) lobe bronchi. Station 11L refers to lymph nodes located between the left upper lobe bronchus (LUL br) and the left lower lobe bronchus (LLL br). https://drive.google.com/file/d/1qKvBOfj0-8FVUYTZ7wYTnvIwtvkkuuho/view

178
Q

NSCLC LN station (#):

bet/ LUL & LLL bronchi / @ LUL/LLL carina

A

station 11L

IASLC LN Map- Radiologic Review with CT Illustration (2014) - RSNA - Fig. 14: Stations 11R and 11L. Coronal reconstructed CT image shows the borders of stations 11R—which is subdivided into stations 11Rs and 11Ri—and 11L. Station 11Rs refers to lymph nodes located between the right upper lobe bronchus (RUL br) and the bronchus intermedius (BI), and station 11Ri denotes lymph nodes located between the right middle (RML br) and right lower (RLL br) lobe bronchi. Station 11L refers to lymph nodes located between the left upper lobe bronchus (LUL br) and the left lower lobe bronchus (LLL br). https://drive.google.com/file/d/1qKvBOfj0-8FVUYTZ7wYTnvIwtvkkuuho/view

179
Q

indication(s) for brain imaging in NSCLC staging

A

> T1 (i.e. >3cm)
central
c/f cN+ (or pN+)
neuro sxs

180
Q

preferred brain imaging for NSCLC staging

A
  1. MRI brain (without & with contrast)
  2. CTH (without & with contrast)

Radiopaedia:
“current MRI technology has been shown to be more sensitive than CT and is the preferred imaging of choice […but] there is no evidence that MRI-based screening improves outcomes when compared to contrast-enhanced CT”
MRI: “delayed sequences may show additional lesions, therefore contrast-enhanced MR is the current standard for small metastases detection”

181
Q

indication(s) for invasive mediastinal staging in NSCLC

A
  • T2 (i.e. >3cm)
  • CT LAD (i.e. >1cm short axis)
  • central tumors
  • ±”SUV>2.5-4.0” (per TSRA)
182
Q

NSCLC

incidence of surprise/occult N2

A

8-15%
(per TSRA)

183
Q

NCCN guideline preop/staging w/u for cIA NSCLC

A
  • labs: CBC
  • CT chest incl upper abd with contrast <60d
  • PET-CT <60d
  • PFTs
  • bronch (preferably intraop)
  • ± invasive mediastinal staging
184
Q

NCCN guideline preop/staging w/u for cIB-IIIA (N<2) NSCLC

A
  • labs: CBC
  • CT chest incl upper abd with contrast <60d
  • PET-CT <60d
  • PFTs
  • bronch
  • invasive mediastinal staging
  • MRI brain with contrast
  • ± MRI spine/thoracic inlet with contrast if superior sulcus
  • molecular testing (re: periop tx)
185
Q

NCCN guideline preop/staging w/u for IIIB+ (N≥2) NSCLC

A
  • labs: CBC
  • CT chest incl upper abd with contrast
  • PET-CT
  • PFTs
  • bronch
  • invasive mediastinal staging
  • MRI brain with contrast
  • bx confirmation of N3 or M+
  • ± thora/pericardio-centesis if M1a
  • molecular testing (re: periop tx)
186
Q

Pancoast syndrome features/sxs

A
  • shoulder/arm pain, paresthesias, paresis
  • atrophy of hand muscles
  • Horner’s syndrome (miosis, ptosis, anhidrosis)
187
Q

additional preop/staging w/u for Pancoast NSCLC if +suggestive sxs

A

MRI chest with contrast
to eval brachial plexus and/or spine

NCCN for T3/T4: “MRI with contrast of spine + thoracic inlet for superior sulcus lesions abutting the spine, subclavian vessels, or brachial plexus”

188
Q

NSCLC

NCCN options for staging ± re-staging of mediastinum in cN2 in setting of induction/neodjuvant + planned resxn

A
  • pre-tx EBUS for staging ± med for poss re-staging
  • pre-tx med + no invasive re-staging

NCCN:
- Repeat mediastinoscopy, while possible, is technically difficult and has a lower accuracy compared to primary mediastinoscopy. One possible strategy is to perform EBUS (± EUS) in the initial pretreatment evaluation and reserve mediastinoscopy for nodal restaging after neoadjuvant therapy.
- The majority of NCCN Member Institutions prefer EBUS for initial mediastinal staging, reserving mediastinoscopy for possible restaging.
- The majority of NCCN Member Institutions do not pathologically restage mediastinal lymph nodes after induction therapy and prior to surgery.

189
Q

NSCLC

Is re-staging of mediastinum in cN2 after induction/neodjuvant mandatory?

A

NO

NCCN:
- Repeat mediastinoscopy, while possible, is technically difficult and has a lower accuracy compared to primary mediastinoscopy. One possible strategy is to perform EBUS (± EUS) in the initial pretreatment evaluation and reserve mediastinoscopy for nodal restaging after neoadjuvant therapy.
- The majority of NCCN Member Institutions prefer EBUS for initial mediastinal staging, reserving mediastinoscopy for possible restaging.
- The majority of NCCN Member Institutions do not pathologically restage mediastinal lymph nodes after induction therapy and prior to surgery.

190
Q

NSCLC

NCCN re-staging w/u after systemic tx before/during oligometastatic paradigm

A

CT chest with contrast AND/OR PET-CT

191
Q

NSCLC

NCCN re-staging w/u after neoadjuvant/induction tx

A

CT chest ± PET-CT

192
Q

NSCLC

definition of bulky LN dz

A
  • short-axis >2cm
  • extranodal extension (on CT)
  • ± single v multi-station
193
Q

sensitivity of chest wall pain for bony involvement/invasion of a peripheral/chest wall-adjacent NSCLC tumor

A

90%

194
Q

NCCN guideline preop/staging w/u for SCLC

A
  • labs: CBC, LFTs, Cr/BUN
  • path review
  • CT C/A/P with contrast
  • ± PET-CT
  • MRI brain with contrast
  • molecular testing (re: periop tx)
    + for limited stage:
  • ± thoracentesis if ⊕effusion
  • ± bone XR or MRI if PET equivocal
  • ± bone bx if bone imaging equivocal
  • PFTs (before surg or RT)
  • invasive mediastinal staging
195
Q

modern SCLC limited stage definition (per NCCN)

A

cI-III (TanyNanyM0)
that can be safely tx with definitive RT (old: “in a single radiation field” / current: “in a tolerable radiation plan”)

196
Q

modern SCLC extensive stage definition (per NCCN)

A

cIV (TanyNanyM1a/b/c)
dz too extensive or bulky to be safely tx with definitive RT / canNOT be tx (old: “in a single radiation field” / current: “in a tolerable radiation plan”)

197
Q

NCCN guideline preop/staging w/u for bronchopulmonary carcinoid/NET (neuroendocrine tumor)

A
  • CT chest with contrast
  • CT or MRI A/P with contrast (multi-phase)
  • ± PET-CT (dotatate)
  • ± MRI brain
  • ± bronch (“if clinically indicated”)
  • ± biochemical w/u for Cushing’s or carcinoid syndromes
198
Q

SCLC staging

A

same as NSCLC

(but additionally classified as limited:
cI-III (TanyNanyM0)
that can be safely tx with definitive RT (old: “in a single radiation field” / current: “in a tolerable radiation plan”)
v extensive:
cIV (TanyNanyM1a/b/c)
dz too extensive or bulky to be safely tx with definitive RT / canNOT be tx (old: “in a single radiation field” / current: “in a tolerable radiation plan”)

199
Q

bronchopulmonary carcinoid/NET staging

A

same as NSCLC

200
Q
A

oral boards (15 decks)

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