lung CA staging

Question 1

NSCLC

IIB

stage criteria

Answer 1

either T3 OR N1:
T3 N0
T1-2 N1

Question 2

NSCLC

minimum stage:
either T3 OR N1

Answer 2

IIB

Question 3

NSCLC

stage: T2b N0

Answer 3

IIA
(this is the ONLY IIA)

Question 4

NSCLC

IIA

stage criteria

Answer 4

only T2b N0

T2b = >4-5cm

Question 5

NSCLC

cutoff criteria between I & II

Answer 5

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

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

Question 6

NSCLC

cutoff criteria between II & III

Answer 6

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

incl T4 N1

Question 7

NSCLC

T2 non-size criteria

Answer 7

+VPI
invading main bronchus
atelectasis to hilum

(T2 = >3-5cm)

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

Question 8

NSCLC

IA v IB

differentiating stage criteria

Answer 8

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

Question 9

NSCLC

T2 by size

Answer 9

>3-5cm

OR +VPI OR invading main bronchus OR atelectasis to hilum

Question 10

NSCLC

For T size criteria, lower limit = inclusive?

Answer 10

NO

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

Question 11

NSCLC

For T size criteria, upper limit = inclusive?

Answer 11

YES

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

Question 12

NSCLC

minimum T stage invading visceral pleura (+VPI)

Answer 12

T2a

Question 13

NSCLC

minimum T stage invading main bronchus

but not carina

Answer 13

T2a

Question 14

NSCLC

minimum T stage with +atelectasis to hilum

Answer 14

T2a

Question 15

NSCLC

T1a size

Answer 15

≤1cm

i.e. up to 1cm

Question 16

NSCLC

≤1cm

i.e. up to 1cm

Answer 16

T1a size

Question 17

NSCLC

T1b size

Answer 17

>1-2cm

Question 18

NSCLC

>1-2cm

Answer 18

T1b size

Question 19

NSCLC

T1c size

Answer 19

>2-3cm

Question 20

NSCLC

>2-3cm

Answer 20

T1c size

Question 21

NSCLC

T2a size

Answer 21

>3-4cm

Question 22

NSCLC

>3-4cm

Answer 22

T2a size

Question 23

NSCLC

T2b size

Answer 23

>4-5cm

Question 24

NSCLC

>4-5cm

Answer 24

T2b size

Question 25

# NSCLC T1 size

Answer 25

\>0-3cm

Question 26

# NSCLC \>0-3cm

Answer 26

T1 size

Question 27

# NSCLC T2 size

Answer 27

\>3-5cm

Question 28

# NSCLC \>3-5cm

Answer 28

T2 size

Question 29

# NSCLC T3 size

Answer 29

\>5-7cm

Question 30

# NSCLC \>5-7cm

Answer 30

T3 size

Question 31

# NSCLC T4 size

Answer 31

\>7cm

Question 32

# NSCLC \>7cm

Answer 32

T4 size

Question 33

# NSCLC minimum T stage invading chest wall

Answer 33

T3

Question 34

# NSCLC minimum T stage invading pericardium

Answer 34

T3

Question 35

# NSCLC minimum T stage invading phrenic nerve

Answer 35

T3

Question 36

# NSCLC minimum T stage with satellite nodule(s) in same lobe | ipsilateral (obviously)

Answer 36

T3

Question 37

# NSCLC minimum T stage invading mediastinum

Answer 37

T4

Question 38

# NSCLC minimum T stage invading diaphragm

Answer 38

T4

Question 39

# NSCLC minimum T stage invading heart

Answer 39

T4

Question 40

# NSCLC minimum T stage invading great vessels

Answer 40

T4

Question 41

# NSCLC minimum T stage invading RLN

Answer 41

T4

Question 42

# NSCLC minimum T stage invading carina

Answer 42

T4

Question 43

# NSCLC minimum T stage invading trachea

Answer 43

T4

Question 44

# NSCLC minimum T stage invading spine/vertebral column

Answer 44

T4

Question 45

# NSCLC minimum T stage invading esophagus

Answer 45

T4

Question 46

# NSCLC minimum T stage with satellite nodule(s) in different lobe | still ipsilateral

Answer 46

T4

Question 47

# NSCLC T3 non-size criteria

Answer 47

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

Question 48

# NSCLC T4 non-size criteria

Answer 48

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)

Question 49

# NSCLC N0

Answer 49

self-explanatory

Question 50

# NSCLC N1

Answer 50

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

Question 51

# NSCLC N2

Answer 51

**ipsilateral mediastinal LN** incl 7 can be multiple

Question 52

# NSCLC N3

Answer 52

supraclavicular OR any contralateral LN

Question 53

# NSCLC M0

Answer 53

self-explanatory

Question 54

# NSCLC M1a

Answer 54

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

Question 55

# NSCLC M1b

Answer 55

single extrathoracic metastasis

Question 56

# NSCLC M1c

Answer 56

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

Question 57

# NSCLC T stage of a superficial spreading tumor in central airways

Answer 57

T1a ## Footnote "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."

Question 58

# NSCLC T stage of a superficial spreading tumor

Answer 58

T1a ## Footnote "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."

Question 59

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

Answer 59

T1mi | minimally invasive ## Footnote "Solitary adenocarcinoma (≤3cm), with a predominantly lepidic pattern and ≤5mm invasion in greatest dimension in any one focus."

Question 60

# NSCLC T1mi

Answer 60

≤3cm total size (single) lepidic ≤5mm invasive component | minimally invasive ## Footnote "Solitary adenocarcinoma (≤3cm), with a predominantly lepidic pattern and ≤5mm invasion in greatest dimension in any one focus."

Question 61

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

Answer 61

YES

Question 62

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

Answer 62

NO

Question 63

# NSCLC IA | stage criteria

Answer 63

T1 N0 | T1a/b/c = IA1/2/3

Question 64

# NSCLC stage: T1 N0

Answer 64

IA

Question 65

# NSCLC IB | stage criteria

Answer 65

T2aN0 | *includes* T2a by non-size criteria

Question 66

# NSCLC stage: T2aN0 | including if T2a by non-size criteria

Answer 66

IB

Question 67

# NSCLC IIIA | stage criteria

Answer 67

T4 N0 T3-4 N1 T1-2 N2

Question 68

# NSCLC stage: T4 N0

Answer 68

IIIA

Question 69

# NSCLC stage: T1-2 N2

Answer 69

IIIA

Question 70

# NSCLC stage: T3-4 N1

Answer 70

IIIA

Question 71

# NSCLC IIIB | stage criteria

Answer 71

T3-4 N2 T1-2 N3

Question 72

# NSCLC stage: T3-4 N2

Answer 72

IIIB

Question 73

# NSCLC stage: T1-2 N3

Answer 73

IIIB

Question 74

# NSCLC IIIC | stage criteria

Answer 74

T3-4 N3

Question 75

# NSCLC stage: T3-4 N3

Answer 75

IIIC

Question 76

# NSCLC IVA | stage criteria

Answer 76

M1a OR M1b (M1a = ipsilateral pleural, pericardial, contralateral lung; M1b = single extrathoracic met) | *regardless* of T/N

Question 77

# NSCLC stage: M1a

Answer 77

**IVA** (M1a = ipsilateral pleural, pericardial, contralateral lung; M1b = single extrathoracic met) | *regardless* of T/N

Question 78

# NSCLC stage: M1b

Answer 78

**IVA** (M1a = ipsilateral pleural, pericardial, contralateral lung; M1b = single extrathoracic met) | *regardless* of T/N

Question 79

# NSCLC IVB | stage criteria

Answer 79

M1c (multiple extrathoracic mets) | *regardless* of T/N

Question 80

# NSCLC stage: M1c

Answer 80

IVB (M1c = multiple extrathoracic mets) | *regardless* of T/N

Question 81

# NSCLC station 1 LNs general/named area(s)

Answer 81

[low] cervical, supraclavicular, sternal notch

Question 82

# NSCLC station 1R/1L anatomic dividing line

Answer 82

midline trachea

Question 83

# NSCLC station 2 LNs general/named area(s)

Answer 83

upper paratracheal & pretracheal (to L border)

Question 84

# NSCLC station 2R/2L anatomic dividing line

Answer 84

L lateral border of trachea

Question 85

# NSCLC station 4R/4L anatomic dividing line

Answer 85

L lateral border of trachea

Question 86

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

Answer 86

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

Question 87

# NSCLC station 3aR/3aL anatomic dividing line

Answer 87

midline trachea

Question 88

# NSCLC station 3pR/3pL anatomic dividing line

Answer 88

N/A | only 3a is divided into R/L

Question 89

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

Answer 89

lower paratracheal & pretracheal

Question 90

# NSCLC station 5 LNs general/named area(s)

Answer 90

subaortic / aortopulmonary (AP) window | lateral to ligamentum arteriosum

Question 91

# NSCLC station 6 LNs general/named area(s)

Answer 91

para-aortic / asc Ao or phrenic | anterior & lateral to asc Ao & arch

Question 92

# NSCLC station 7 LNs general/named area(s)

Answer 92

subcarinal

Question 93

# NSCLC station 8 LNs general/named area(s)

Answer 93

para-esophageal | adjacent to wall of esophagus & to R&L of midline, excluding subcarinal

Question 94

# NSCLC station 9 LNs general/named area(s)

Answer 94

(inferior) pulmonary ligament | within the ligament

Question 95

# NSCLC station 10 LNs general/named area(s)

Answer 95

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

Question 96

# NSCLC station 11 LNs general/named area(s)

Answer 96

interlobar | between origin of lobar bronchi

Question 97

# NSCLC station 12 LNs general/named area(s)

Answer 97

lobar | adjacent to lobar bronchi

Question 98

# NSCLC station 13 LNs general/named area(s)

Answer 98

segmental | adjacent to segmental bronchi

Question 99

# NSCLC station 14 LNs general/named area(s)

Answer 99

subsegmental | adjacent to subsegmental bronchi

Question 100

# NSCLC station 1R borders

Answer 100

**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?)

Question 101

# NSCLC station 1L borders

Answer 101

**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?)

Question 102

# NSCLC station 1R/L upper border

Answer 102

- upper: lower border of cricoid cartilage

Question 103

# NSCLC station 1R/L lower border

Answer 103

- lower: upper border of manumbrium in midline, upper border of clavicles laterally

Question 104

# NSCLC station 1R/L medial border

Answer 104

- medial: midline trachea

Question 105

# NSCLC station 2R borders

Answer 105

**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?)

Question 106

# NSCLC station 2R lower border

Answer 106

- lower: lower border of (L?) innominate vein at intersection with (R border of?) trachea

Question 107

# NSCLC station 2R medial border

Answer 107

- medial: L border of trachea

Question 108

# NSCLC station 2R/L upper border

Answer 108

- upper: apex of R lung/pleural space laterally, upper border manubrium medially

Question 109

# NSCLC station 2L borders

Answer 109

**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?)

Question 110

# NSCLC station 2L lower border

Answer 110

- lower: upper border Ao arch

Question 111

# NSCLC station 2L medial border

Answer 111

- medial: L border of trachea

Question 112

# NSCLC station 3a borders

Answer 112

**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?)

Question 113

# NSCLC station 3a/p upper border

Answer 113

**prevascular & retrotracheal** - upper: chest apex

Question 114

# NSCLC station 3a/p lower border

Answer 114

**prevascular & retrotracheal** - lower: level of carina

Question 115

# NSCLC station 3a anterior border

Answer 115

**prevascular** - anterior: posterior border of sternum

Question 116

# NSCLC station 3a posterior border

Answer 116

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

Question 117

# NSCLC station 3aR posterior border

Answer 117

**prevascular** - posterior: anterior border of SVC on R

Question 118

# NSCLC station 3aL posterior border

Answer 118

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

Question 119

# NSCLC station 3p borders

Answer 119

**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?)

Question 120

# NSCLC station 3p anterior border

Answer 120

**retrotracheal** - (anterior: posterior border of trachea?)

Question 121

# NSCLC station 3p posterior border

Answer 121

**retrotracheal** - (posterior: anterior border of spine?)

Question 122

# NSCLC station 3p lateral border

Answer 122

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

Question 123

# NSCLC station 4R borders

Answer 123

**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 ## Footnote - 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

Question 124

# NSCLC station 4R upper border

Answer 124

**R lower paratracheal** & pretracheal - upper: lower border of innominate vein at intersection with trachea | includes R pretracheal ## Footnote - 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

Question 125

# NSCLC station 4R lower border

Answer 125

**R lower paratracheal** & pretracheal - lower: lower border of azygos vein | includes R pretracheal ## Footnote - 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

Question 126

# NSCLC station 4R medial border

Answer 126

**R lower paratracheal** & pretracheal - medial: L border of trachea | includes R pretracheal ## Footnote - 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

Question 127

# NSCLC station 4L borders

Answer 127

**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) ## Footnote 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

Question 128

# NSCLC station 4L upper border

Answer 128

**L lower paratracheal** - upper: upper border of Ao arch ## Footnote 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

Question 129

# NSCLC station 4L lower border

Answer 129

**L lower paratracheal** - lower: upper border of L PA ## Footnote 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

Question 130

# NSCLC station 4L medial border

Answer 130

**L lower paratracheal** - medial: L border of trachea ## Footnote 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

Question 131

# NSCLC station 4L lateral border

Answer 131

**L lower paratracheal** - lateral: ligamentum arteriosum ## Footnote 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

Question 132

# NSCLC station 5 borders

Answer 132

**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" ## Footnote 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

Question 133

# NSCLC station 5 upper border

Answer 133

**sub-aortic / PA window** - upper: lower border of Ao arch | subaortic LN laterla to ligamentum arteriosum ## Footnote 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

Question 134

# NSCLC station 5 lower border

Answer 134

**sub-aortic / PA window** - lower: upper border of L PA | subaortic LN laterla to ligamentum arteriosum ## Footnote 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

Question 135

# NSCLC station 5 medial border

Answer 135

**sub-aortic / PA window** - medial: ligamentum arteriosum | subaortic LN laterla to ligamentum arteriosum ## Footnote 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

Question 136

# NSCLC station 6 borders

Answer 136

**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 ## Footnote 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

Question 137

# NSCLC station 6 upper border

Answer 137

**para-aortic** / asc Ao / phrenic - upper: upper border of Ao arch (line tangential to) | anterior & lateral to asc Ao & arch ## Footnote 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

Question 138

# NSCLC station 6 lower border

Answer 138

**para-aortic** / asc Ao / phrenic - lower: lower border of Ao arch | anterior & lateral to asc Ao & arch ## Footnote 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

Question 139

# NSCLC station 6 medial border

Answer 139

**para-aortic** / asc Ao / phrenic - (medial: Ao arch) | anterior & lateral to asc Ao & arch ## Footnote 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

Question 140

# NSCLC station 7 borders

Answer 140

**subcarinal** - upper: carina - lower: lower border of BI on R, upper border of LLL bronchus on L - (lateral: inner/medial border of bronchi) ## Footnote IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view

Question 141

station 7 upper border

Answer 141

**subcarinal** - upper: carina ## Footnote IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view

Question 142

# NSCLC station 7 lower border

Answer 142

**subcarinal** - lower: lower border of BI on R, upper border of LLL bronchus on L ## Footnote IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view

Question 143

# NSCLC station 7 lateral border

Answer 143

**subcarinal** - (lateral: inner/medial border of bronchi) ## Footnote IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view

Question 144

# NSCLC station 8 borders

Answer 144

**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" ## Footnote 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

Question 145

# NSCLC station 8 upper border

Answer 145

**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" ## Footnote 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

Question 146

# NSCLC station 8 lower border

Answer 146

**para-esophageal** - lower: diaphragm | "adjacent to esophagus wall & to R or L of midline, excl subcarinal LN" ## Footnote 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

Question 147

# NSCLC station 8R/8L anatomic dividing line

Answer 147

midline esophagus? *undefined by IASLC* | "adjacent to esophagus wall & to R or L of midline, excl subcarinal LN" ## Footnote 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

Question 148

# NSCLC station 9 borders

Answer 148

**IPL** / (inf) pulm ligament - upper: lower border IPV - lower: diaphragm - (lateral/medial: borders of IPL?) | "lying within the pulmonary ligament" ## Footnote - 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

Question 149

# NSCLC station 9 upper border

Answer 149

**IPL** / (inf) pulm ligament - upper: lower border IPV | "lying within the pulmonary ligament" ## Footnote - 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

Question 150

# NSCLC station 9 lower border

Answer 150

**IPL** / (inf) pulm ligament - lower: diaphragm | "lying within the pulmonary ligament" ## Footnote - 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

Question 151

# NSCLC station 10 borders

Answer 151

**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" ## Footnote - 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

Question 152

# NSCLC station 10 upper border

Answer 152

**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" ## Footnote - 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

Question 153

# NSCLC station 10 lower border

Answer 153

**hilar** - lower: "interlobar region bilaterally" = upper border of first lobar bronchus takeoff? | "immed adjacent to mainstem bronchus & hilar vessels incl prox PV & mPA" ## Footnote - 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

Question 154

# NSCLC station 11 borders

Answer 154

**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 ## Footnote 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

Question 155

# NSCLC station 11Rs definition

Answer 155

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

Question 156

# NSCLC station 11Ri definition

Answer 156

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

Question 157

# NSCLC station 11L definition

Answer 157

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

Question 158

# NSCLC zones of ambiguity in the IASLC LN map

Answer 158

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

Question 159

# NSCLC station 12 borders

Answer 159

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

Question 160

# NSCLC station 13 borders

Answer 160

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

Question 161

# NSCLC station 14 borders

Answer 161

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

Question 162

# NSCLC LN station (#): [low] cervical, supraclavicular, sternal notch

Answer 162

station 1 LNs

Question 163

# NSCLC LN station (#): upper paratracheal & pretracheal

Answer 163

station 2 LNs

Question 164

# NSCLC LN station (#): pre-vascular & retrotracheal

Answer 164

station 3a/p LNs | pre-tracheal (anterior to trachea) LN are actually encompassed by 2R/4R

Question 165

# NSCLC LN station (#): lower paratracheal & pretracheal

Answer 165

station 4R/L LNs

Question 166

# NSCLC LN station (#): subaortic / aortopulmonary (AP) window | lateral to ligamentum arteriosum

Answer 166

station 5 LNs

Question 167

# NSCLC LN station (#): para-aortic / asc Ao or phrenic | anterior & lateral to asc Ao & arch

Answer 167

station 6 LNs

Question 168

# NSCLC LN station (#): subcarinal

Answer 168

station 7 LNs

Question 169

# NSCLC LN station (#): para-esophageal | adjacent to wall of esophagus & to R&L of midline, excluding subcarinal

Answer 169

station 8 LNs

Question 170

# NSCLC LN station (#): (inferior) pulmonary ligament | within the ligament

Answer 170

station 9 LNs

Question 171

# NSCLC LN station (#): hilar | adjacent to mainstem bronchi & hilar vessels incl prox veins & main PA

Answer 171

station 10 LNs

Question 172

# NSCLC LN station (#): interlobar | between origin of lobar bronchi @ bronchial carina

Answer 172

station 11 LNs

Question 173

# NSCLC LN station (#): lobar | adjacent to lobar bronchi

Answer 173

station 12 LNs

Question 174

# NSCLC LN station (#): segmental | adjacent to segmental bronchi

Answer 174

station 13 LNs

Question 175

# NSCLC LN station (#): subsegmental | adjacent to subsegmental bronchi

Answer 175

station 14 LNs

Question 176

# NSCLC LN station (#): bet/ RUL & BI bronchi / @ RUL/BIcarina

Answer 176

station 11Rs ## Footnote 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

Question 177

# NSCLC LN station (#): bet/ RML & RLL bronchi / @ RML/RLL carina

Answer 177

station 11Ri ## Footnote 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

Question 178

# NSCLC LN station (#): bet/ LUL & LLL bronchi / @ LUL/LLL carina

Answer 178

station 11L ## Footnote 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

Question 179

indication(s) for brain imaging in NSCLC staging

Answer 179

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

Question 180

preferred brain imaging for NSCLC staging

Answer 180

1. MRI brain (without & with contrast) 2. CTH (without & with contrast) ## Footnote 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"

Question 181

indication(s) for invasive mediastinal staging in NSCLC

Answer 181

- T2 (i.e. \>3cm) - CT LAD (i.e. \>1cm short axis) - central tumors - ±"SUV>2.5-4.0" (per TSRA)

Question 182

# NSCLC incidence of surprise/occult N2

Answer 182

8-15% (per TSRA)

Question 183

NCCN guideline preop/staging w/u for cIA NSCLC

Answer 183

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

Question 184

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

Answer 184

- 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)

Question 185

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

Answer 185

- 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)

Question 186

Pancoast syndrome features/sxs

Answer 186

- shoulder/arm pain, paresthesias, paresis - atrophy of hand muscles - Horner's syndrome (miosis, ptosis, anhidrosis)

Question 187

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

Answer 187

MRI chest with contrast to eval brachial plexus and/or spine ## Footnote NCCN for T3/T4: "MRI with contrast of spine + thoracic inlet for superior sulcus lesions abutting the spine, subclavian vessels, or brachial plexus"

Question 188

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

Answer 188

- pre-tx EBUS for staging ± med for poss re-staging - pre-tx med + no invasive re-staging ## Footnote 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.

Question 189

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

Answer 189

NO ## Footnote 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.

Question 190

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

Answer 190

CT chest with contrast AND/OR PET-CT

Question 191

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

Answer 191

CT chest ± PET-CT

Question 192

# NSCLC definition of bulky LN dz

Answer 192

- short-axis \>2cm - extranodal extension (on CT) - ± single v multi-station

Question 193

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

Answer 193

90%

Question 194

NCCN guideline preop/staging w/u for SCLC

Answer 194

- 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

Question 195

modern SCLC limited stage definition (per NCCN)

Answer 195

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

Question 196

modern SCLC extensive stage definition (per NCCN)

Answer 196

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")

Question 197

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

Answer 197

- 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

Question 198

SCLC staging

Answer 198

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")

Question 199

bronchopulmonary carcinoid/NET staging

Answer 199

same as NSCLC