lung CA staging Flashcards
NSCLC
IIB
stage criteria
either T3 OR N1:
T3 N0
T1-2 N1
NSCLC
minimum stage:
either T3 OR N1
IIB
NSCLC
stage: T2b N0
IIA
(this is the ONLY IIA)
NSCLC
IIA
stage criteria
only T2b N0
T2b = >4-5cm
NSCLC
cutoff criteria between I & II
>T2a OR >N0
i.e. >4cm & N0 OR <5cm & N1
i.e. T2b+ or N1+ = at least II
NSCLC
cutoff criteria between II & III
T4 (>7cm) N0
T3 (>5cm) N1
any N2+
incl T4 N1
NSCLC
T2 non-size criteria
+VPI
invading main bronchus
atelectasis to hilum
(T2 = >3-5cm)
if + above, T2a v T2b still by <4cm v >4-5cm
NSCLC
IA v IB
differentiating stage criteria
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
NSCLC
T2 by size
>3-5cm
OR +VPI OR invading main bronchus OR atelectasis to hilum
NSCLC
For T size criteria, lower limit = inclusive?
NO
e.g. T1b is >1 - </=2 cm, i.e. up to 2cm
NSCLC
For T size criteria, upper limit = inclusive?
YES
e.g. T1c is >2 - </=3 cm, i.e. up to 3cm
NSCLC
minimum T stage invading visceral pleura (+VPI)
T2a
NSCLC
minimum T stage invading main bronchus
but not carina
T2a
NSCLC
minimum T stage with +atelectasis to hilum
T2a
NSCLC
T1a size
≤1cm
i.e. up to 1cm
NSCLC
≤1cm
i.e. up to 1cm
T1a size
NSCLC
T1b size
>1-2cm
NSCLC
>1-2cm
T1b size
NSCLC
T1c size
>2-3cm
NSCLC
>2-3cm
T1c size
NSCLC
T2a size
>3-4cm
NSCLC
>3-4cm
T2a size
NSCLC
T2b size
>4-5cm
NSCLC
>4-5cm
T2b size
NSCLC
T1 size
>0-3cm
NSCLC
>0-3cm
T1 size
NSCLC
T2 size
>3-5cm
NSCLC
>3-5cm
T2 size
NSCLC
T3 size
>5-7cm
NSCLC
>5-7cm
T3 size
NSCLC
T4 size
>7cm
NSCLC
>7cm
T4 size
NSCLC
minimum T stage invading chest wall
T3
NSCLC
minimum T stage invading pericardium
T3
NSCLC
minimum T stage invading phrenic nerve
T3
NSCLC
minimum T stage with satellite nodule(s) in same lobe
ipsilateral (obviously)
T3
NSCLC
minimum T stage invading mediastinum
T4
NSCLC
minimum T stage invading diaphragm
T4
NSCLC
minimum T stage invading heart
T4
NSCLC
minimum T stage invading great vessels
T4
NSCLC
minimum T stage invading RLN
T4
NSCLC
minimum T stage invading carina
T4
NSCLC
minimum T stage invading trachea
T4
NSCLC
minimum T stage invading spine/vertebral column
T4
NSCLC
minimum T stage invading esophagus
T4
NSCLC
minimum T stage with satellite nodule(s) in different lobe
still ipsilateral
T4
NSCLC
T3 non-size criteria
invasion of resectable ipsilateral structures (i.e. chest wall, pericardium, phrenic nerve, same lobe as 1*)
NSCLC
T4 non-size criteria
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)
NSCLC
N0
self-explanatory
NSCLC
N1
ipsilateral pulmonary/hilar LN
i.e. >/=10
can be multiple
NSCLC
N2
ipsilateral mediastinal LN
incl 7
can be multiple
NSCLC
N3
supraclavicular OR any contralateral LN
NSCLC
M0
self-explanatory
NSCLC
M1a
satellite nodule(s) in contralateral lung
pleural/pericard dissemination (effusion or nodules)
NSCLC
M1b
single extrathoracic metastasis
NSCLC
M1c
multiple extrathoracic metastases
does NOT have to be >1 site, i.e. multiple mets in SAME organ/site count
NSCLC
T stage of a superficial spreading tumor in central airways
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.”
NSCLC
T stage of a superficial spreading tumor
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.”
NSCLC
T stage of a lepidic tumor (max 3cm) with ≤5mm invasive component
T1mi
minimally invasive
“Solitary adenocarcinoma (≤3cm), with a predominantly lepidic pattern and ≤5mm invasion in greatest dimension in any one focus.”
NSCLC
T1mi
≤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.”
NSCLC
Does direct invasion of primary tumor into LN count as +N?
YES
NSCLC
Does invasion of a +LN into another structure upstage T?
NO
NSCLC
IA
stage criteria
T1 N0
T1a/b/c = IA1/2/3
NSCLC
stage: T1 N0
IA
NSCLC
IB
stage criteria
T2aN0
includes T2a by non-size criteria
NSCLC
stage: T2aN0
including if T2a by non-size criteria
IB
NSCLC
IIIA
stage criteria
T4 N0
T3-4 N1
T1-2 N2
NSCLC
stage: T4 N0
IIIA
NSCLC
stage: T1-2 N2
IIIA
NSCLC
stage: T3-4 N1
IIIA
NSCLC
IIIB
stage criteria
T3-4 N2
T1-2 N3
NSCLC
stage: T3-4 N2
IIIB
NSCLC
stage: T1-2 N3
IIIB
NSCLC
IIIC
stage criteria
T3-4 N3
NSCLC
stage: T3-4 N3
IIIC
NSCLC
IVA
stage criteria
M1a OR M1b
(M1a = ipsilateral pleural, pericardial, contralateral lung;
M1b = single extrathoracic met)
regardless of T/N
NSCLC
stage: M1a
IVA
(M1a = ipsilateral pleural, pericardial, contralateral lung;
M1b = single extrathoracic met)
regardless of T/N
NSCLC
stage: M1b
IVA
(M1a = ipsilateral pleural, pericardial, contralateral lung;
M1b = single extrathoracic met)
regardless of T/N
NSCLC
IVB
stage criteria
M1c
(multiple extrathoracic mets)
regardless of T/N
NSCLC
stage: M1c
IVB
(M1c = multiple extrathoracic mets)
regardless of T/N
NSCLC
station 1 LNs
general/named area(s)
[low] cervical, supraclavicular, sternal notch
NSCLC
station 1R/1L anatomic dividing line
midline trachea
NSCLC
station 2 LNs
general/named area(s)
upper paratracheal
& pretracheal (to L border)
NSCLC
station 2R/2L anatomic dividing line
L lateral border of trachea
NSCLC
station 4R/4L anatomic dividing line
L lateral border of trachea
NSCLC
station 3a/p LNs
general/named area(s)
pre-vascular & retrotracheal
pre-tracheal (anterior to trachea) LN are actually encompassed by 2R/4R
NSCLC
station 3aR/3aL anatomic dividing line
midline trachea
NSCLC
station 3pR/3pL anatomic dividing line
N/A
only 3a is divided into R/L
NSCLC
station 4R/L LNs
general/named area(s)
lower paratracheal
& pretracheal
NSCLC
station 5 LNs
general/named area(s)
subaortic / aortopulmonary (AP) window
lateral to ligamentum arteriosum
NSCLC
station 6 LNs
general/named area(s)
para-aortic
/ asc Ao or phrenic
anterior & lateral to asc Ao & arch
NSCLC
station 7 LNs
general/named area(s)
subcarinal
NSCLC
station 8 LNs
general/named area(s)
para-esophageal
adjacent to wall of esophagus & to R&L of midline, excluding subcarinal
NSCLC
station 9 LNs
general/named area(s)
(inferior) pulmonary ligament
within the ligament
NSCLC
station 10 LNs
general/named area(s)
hilar
adjacent to mainstem bronchi & hilar vessels incl prox veins & main PA
NSCLC
station 11 LNs
general/named area(s)
interlobar
between origin of lobar bronchi
NSCLC
station 12 LNs
general/named area(s)
lobar
adjacent to lobar bronchi
NSCLC
station 13 LNs
general/named area(s)
segmental
adjacent to segmental bronchi
NSCLC
station 14 LNs
general/named area(s)
subsegmental
adjacent to subsegmental bronchi
NSCLC
station 1R borders
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?)
NSCLC
station 1L borders
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?)
NSCLC
station 1R/L upper border
- upper: lower border of cricoid cartilage
NSCLC
station 1R/L lower border
- lower: upper border of manumbrium in midline, upper border of clavicles laterally
NSCLC
station 1R/L medial border
- medial: midline trachea
NSCLC
station 2R borders
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?)
NSCLC
station 2R lower border
- lower: lower border of (L?) innominate vein at intersection with (R border of?) trachea
NSCLC
station 2R medial border
- medial: L border of trachea
NSCLC
station 2R/L upper border
- upper: apex of R lung/pleural space laterally, upper border manubrium medially
NSCLC
station 2L borders
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?)
NSCLC
station 2L lower border
- lower: upper border Ao arch
NSCLC
station 2L medial border
- medial: L border of trachea
NSCLC
station 3a borders
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?)
NSCLC
station 3a/p upper border
prevascular & retrotracheal
- upper: chest apex
NSCLC
station 3a/p lower border
prevascular & retrotracheal
- lower: level of carina
NSCLC
station 3a anterior border
prevascular
- anterior: posterior border of sternum
NSCLC
station 3a posterior border
prevascular
- posterior: anterior border of SVC on R, (anterior border of?) L (common?) carotid artery on L
NSCLC
station 3aR posterior border
prevascular
- posterior: anterior border of SVC on R
NSCLC
station 3aL posterior border
prevascular
- posterior: (anterior border of?) L (common?) carotid artery on L
NSCLC
station 3p borders
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?)
NSCLC
station 3p anterior border
retrotracheal
- (anterior: posterior border of trachea?)
NSCLC
station 3p posterior border
retrotracheal
- (posterior: anterior border of spine?)
NSCLC
station 3p lateral border
retrotracheal
- (lateral: medial border of azygos vein on R, medial border of desc Ao on L?)
NSCLC
station 4R borders
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
NSCLC
station 4R upper border
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
NSCLC
station 4R lower border
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
NSCLC
station 4R medial border
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
NSCLC
station 4L borders
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
NSCLC
station 4L upper border
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
NSCLC
station 4L lower border
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
NSCLC
station 4L medial border
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
NSCLC
station 4L lateral border
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
NSCLC
station 5 borders
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
NSCLC
station 5 upper border
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
NSCLC
station 5 lower border
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
NSCLC
station 5 medial border
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
NSCLC
station 6 borders
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
NSCLC
station 6 upper border
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
NSCLC
station 6 lower border
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
NSCLC
station 6 medial border
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
NSCLC
station 7 borders
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
station 7 upper border
subcarinal
- upper: carina
IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
NSCLC
station 7 lower border
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
NSCLC
station 7 lateral border
subcarinal
- (lateral: inner/medial border of bronchi)
IASLC LN map coronal: https://drive.google.com/file/d/1pvF9aCEMGm2nylaFpgSjNPF5tgcLENiO/view
NSCLC
station 8 borders
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
NSCLC
station 8 upper border
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
NSCLC
station 8 lower border
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
NSCLC
station 8R/8L anatomic dividing line
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
NSCLC
station 9 borders
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
NSCLC
station 9 upper border
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
NSCLC
station 9 lower border
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
NSCLC
station 10 borders
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
NSCLC
station 10 upper border
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
NSCLC
station 10 lower border
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
NSCLC
station 11 borders
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
NSCLC
station 11Rs definition
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
NSCLC
station 11Ri definition
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
NSCLC
station 11L definition
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
NSCLC
zones of ambiguity in the IASLC LN map
- 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
NSCLC
station 12 borders
lobar
N/A
not defined by borders, rather by r/t bronchi:
- adjacent to lobar bronchi (distal to bifurc)
NSCLC
station 13 borders
segmental
N/A
not defined by borders, rather by r/t bronchi:
- adjacent to segmental bronchi
NSCLC
station 14 borders
subsegmental
N/A
not defined by borders, rather by r/t bronchi:
- adjacent to subsegmental bronchi
NSCLC LN station (#):
[low] cervical, supraclavicular, sternal notch
station 1 LNs
NSCLC LN station (#):
upper paratracheal
& pretracheal
station 2 LNs
NSCLC LN station (#):
pre-vascular & retrotracheal
station 3a/p LNs
pre-tracheal (anterior to trachea) LN are actually encompassed by 2R/4R
NSCLC LN station (#):
lower paratracheal
& pretracheal
station 4R/L LNs
NSCLC LN station (#):
subaortic / aortopulmonary (AP) window
lateral to ligamentum arteriosum
station 5 LNs
NSCLC LN station (#):
para-aortic
/ asc Ao or phrenic
anterior & lateral to asc Ao & arch
station 6 LNs
NSCLC LN station (#):
subcarinal
station 7 LNs
NSCLC LN station (#):
para-esophageal
adjacent to wall of esophagus & to R&L of midline, excluding subcarinal
station 8 LNs
NSCLC LN station (#):
(inferior) pulmonary ligament
within the ligament
station 9 LNs
NSCLC LN station (#):
hilar
adjacent to mainstem bronchi & hilar vessels incl prox veins & main PA
station 10 LNs
NSCLC LN station (#):
interlobar
between origin of lobar bronchi @ bronchial carina
station 11 LNs
NSCLC LN station (#):
lobar
adjacent to lobar bronchi
station 12 LNs
NSCLC LN station (#):
segmental
adjacent to segmental bronchi
station 13 LNs
NSCLC LN station (#):
subsegmental
adjacent to subsegmental bronchi
station 14 LNs
NSCLC LN station (#):
bet/ RUL & BI bronchi / @ RUL/BIcarina
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
NSCLC LN station (#):
bet/ RML & RLL bronchi / @ RML/RLL carina
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
NSCLC LN station (#):
bet/ LUL & LLL bronchi / @ LUL/LLL carina
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
indication(s) for brain imaging in NSCLC staging
> T1 (i.e. >3cm)
central
c/f cN+ (or pN+)
neuro sxs
preferred brain imaging for NSCLC staging
- MRI brain (without & with contrast)
- 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”
indication(s) for invasive mediastinal staging in NSCLC
- T2 (i.e. >3cm)
- CT LAD (i.e. >1cm short axis)
- central tumors
- ±”SUV>2.5-4.0” (per TSRA)
NSCLC
incidence of surprise/occult N2
8-15%
(per TSRA)
NCCN guideline preop/staging w/u for cIA NSCLC
- labs: CBC
- CT chest incl upper abd with contrast <60d
- PET-CT <60d
- PFTs
- bronch (preferably intraop)
- ± invasive mediastinal staging
NCCN guideline preop/staging w/u for cIB-IIIA (N<2) NSCLC
- 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)
NCCN guideline preop/staging w/u for IIIB+ (N≥2) NSCLC
- 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)
Pancoast syndrome features/sxs
- shoulder/arm pain, paresthesias, paresis
- atrophy of hand muscles
- Horner’s syndrome (miosis, ptosis, anhidrosis)
additional preop/staging w/u for Pancoast NSCLC if +suggestive sxs
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”
NSCLC
NCCN options for staging ± re-staging of mediastinum in cN2 in setting of induction/neodjuvant + planned resxn
- 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.
NSCLC
Is re-staging of mediastinum in cN2 after induction/neodjuvant mandatory?
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.
NSCLC
NCCN re-staging w/u after systemic tx before/during oligometastatic paradigm
CT chest with contrast AND/OR PET-CT
NSCLC
NCCN re-staging w/u after neoadjuvant/induction tx
CT chest ± PET-CT
NSCLC
definition of bulky LN dz
- short-axis >2cm
- extranodal extension (on CT)
- ± single v multi-station
sensitivity of chest wall pain for bony involvement/invasion of a peripheral/chest wall-adjacent NSCLC tumor
90%
NCCN guideline preop/staging w/u for SCLC
- 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
modern SCLC limited stage definition (per NCCN)
cI-III (TanyNanyM0)
that can be safely tx with definitive RT (old: “in a single radiation field” / current: “in a tolerable radiation plan”)
modern SCLC extensive stage definition (per NCCN)
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”)
NCCN guideline preop/staging w/u for bronchopulmonary carcinoid/NET (neuroendocrine tumor)
- 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
SCLC staging
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”)
bronchopulmonary carcinoid/NET staging
same as NSCLC
