Radiology of Lung Cancer and Staging

Question 1

CXR; lung cancer

Answer 1

• Lesions often more subtle
• Beware of lesions behind the heart and hila
• Compare with previous films
• Always look at review areas

Question 2

What is a pulmonary nodule/mass?

Answer 2

• Pulmonary mass is an opacity in lung over 3cm with no mediastinal adenopathy or atelectasis
• Pulmonary nodule is an opacity in lung up to 3cm with no mediastinal adenopathy or atelectasis

Question 3

What is TNM staging?

Answer 3

• How big it is and how far has it spread /Size and position of the tumour (T)
• Whether cancer cells have spread into the lymph nodes (N)
• Whether the tumour has spread anywhere else in the body ie metastases (M)

Question 4

T1

Answer 4

• Tumour ≤3 cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of involvement of the main bronchus
• T1a minimally invasive adenocarcinoma Tumor <=1 cm in greatest dimension
• T1b Tumor <=2 cm
• T1c<=3

Question 5

T2

Answer 5

• Tumour >3 cm but 5 cm or tumour with any of the following features (T2 tumors with these features are classified T2a if ≤5 cm)
  
  • Involves main bronchus, but not carina
  • Invades visceral pleura
  • Associated with atelectasis or obstructive pneumonitis that extends to the hilar region involving part or all the lung
• T2a Tumor >3 cm but <4 cm in greatest dimension
• T2b Tumor&raquo_space;4cm but <5 cm in greatest dimension

Question 6

T3

Answer 6

• Tumour >5 cm but <7cm or one that directly invades any of the following:
  
  • chest wall (including superior sulcus tumors)
  • phrenic nerve
  • parietal pericardium
• or separate tumor nodule(s) in the same lobe as the primary

Question 7

T4

Answer 7

• Tumour >7cm or invades any of the following:
  
  • Diaphragm
  • mediastinum
  • heart
  • great vessels
  • trachea
  • recurrent laryngeal nerve
  • esophagus
  • vertebral body
  • carina
• separate tumour nodule(s) in a different ipsilateral lobe

Question 8

PET/CT in staging

Answer 8

• performs whole body staging in a single study excluding cerebral disease
• discloses metastases and other pathology not detected by other means
  
  • unexpected metastases in 10-20%
• excludes metastases where structural imaging abnormal
• Non invasive

Question 9

Limitations of PET CT

Answer 9

• All tests have
• False negative results
• False positive results
• Cost

Question 10

Tissue diagnosis

Answer 10

• Bronchoscopy and EBUS
• Percutaneous image guided biopsy, fluoroscopy/CT/US guided
• Mediastinoscopy to sample mediastinal nodes
• Mediastinotomy for anterior mediastinal nodes
• VATS
• Explorative thoracotomy