Radiology of lung cancer (investigations and staging) Flashcards
What are the steps of a systematic review of a CXR? (8)
Name/marker/rotation/penetration
Lines/metal work
Heart
Mediastinum
Lungs
Bones
Diaphragm
Soft tissue
What do you look at with the heart on a CXR?
Distortion
Enlargement
What do you look at with the mediastinum on a CXR?
Structures beneath the heart
Central airways
Hilar vascular structures should be crisply defined
Widening of mediastinum
Trachea should be central
What do you look at with the lungs on a CXR?
Compare zones
Look for abnormalities
Lung collapse
Mass
Look between ribs for lung detail
Look “behind” the heart
What to look at with bones on a CXR?
Costophrenic angles
Fractures
What are the major review sections on a CXR?
Hila
Lung apices
Behind the heart
Behind the diaphragm
What is the next step after CXR in investigation?
CT scan
What to look at on a CT?
Size
Shape
Atelectasis
Border
Density
Solid or non-solid
Dynamic contrast enhancement >25HU
Growth
What is the difference between a pulmonary nodule and pulmonary mass?
Pulmonary mass is over 3cm with no mediastinal adenopathy or atelectasis.
Pulmonary nodule is less than 3cm no mediastinal adenopathy or atelectasis.
What are solitary pulmonary nodule/mass?
Lung cancer
Metastasis - Breast, renal, seminoma, sarcoma
Benign lung neoplasm - Carcinoid, hamartoma
Infection - Bacterial, TB, fungal
Vascular haematoma
How can tumours be staged?
Clinical history/examination
Performance status
Pulmonary function
TNM
What does the T stand for in TNM?
T = size of tumour
What does staging TX and T0 stand for?
TX= primary tumour cannot be assessed
T0 = No evidence of primary tumour
What does stage T1 mean?
T1 = <3cm surrounded by lung/visceral pleura not involved with main bronchus.
T1a = <=1cm
T1b = <=2cm
T1c = <=3cm
What does stage T2 mean?
T2 = 3-5cm or involved with:
- Main bronchus/carina
- Invades visceral pleura
- Associated with atelectasis, obstructive pneumonitis that extends to hilar region involving part/all of the lung.
T2a = 3-4cm
T2b = 4-5cm
What does stage T3 mean?
T3 = 5-7cm or invading any of:
- Chest wall
- Phrenic nerve
- Parietal pericardium
Or separate tumour nodules in same lobe as primary.
What does stage T4 mean?
> 7cm or invades any of:
- Diaphragm
- Mediastinum
- Heart
- Great vessels
- Trachea
- Recurrent laryngeal nerve
- Oesophagus
- Vertebral body
- Carina
- Separate tumour nodules in a different ipsilateral lobe.
What does the N stand for in TNM staging?
Lymph node involvement
What does stage N0 mean?
No regional lymph node metastases
What does stage N1 mean?
Ipsilateral peribranchial, hilar or intrapulmonary nodes including by direct extension
What does stage N2 mean?
Ipsilateral mediastinal, subcarinal
What does stage N3 mean?
Contralateral mediastinal, contralateral hilar, scalene or supraclavicular
What does the M stand for in TNM staging?
Metastasis
What does M1 mean and subcategories?
M1 = distant metastasis
M1a
- Separate tumour nodules in contralateral lobes
- Tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion
M1b
- Single distant metastasis
M1c
- Multiple distant metastasis
What does PET-CT scans show?
Whole body staging in a single study excluding cerebral disease.
Discloses metastases and other pathology (unexpected metastasis 10-20%).
Excludes metastases where structural imaging abnormal.
Non invasive
What are the methods of tissue diagnosis?
Bronchoscopy
EBUS
Percutaneous image guided biopsy
- Fluoroscopy/CT/US guided
