Lung cancer staging

Lung cancer is the most common cause of cancer related death in the World.

Accurate staging is essential to make estimates of prognosis and to choose the best combination of treatment modalities.

Numerous are the clinical staging procedures, some invasive and some non invasive.

The non invasive imaging modalities can be subdivided in Morphologic like CT and MRI and functional like PET and PET-CT.

Defining malignant involvement of the hilar and most importantly mediastinal lymphnodes is important as the status of these nodes will in many cases determine where there is surgically resectable disease.

A widely accepted definition of normal sized mediastinal lymphnode is a short axis diameter of <1cm on a transverse CT scan image.

According to a systematic review of the medical literature relating to the accuracy of CT for non invasive staging of the mediastinum in patients with lung cancer the pooled sensitivity and specificity for identifying mediastinal lymphnode metastases were 51% and 86% respectively confirming that CT has a limited ability either to rule in or exclude mediastinal metastasis.

CT is clearly an imperfect means of staging the mediastinal nodes but it remains the best overall anatomic study available for the chest.

According to international guidelines published in 2007 in patients with extensive mediastinal infiltration Invasive Staging is not necessary.

In patients with discrete mediastinal nodes enlargement staging by CT or PET/CT is not sufficiently accurate (even with PET +)

In patients with central tumor or N1 lymphnode invasive staging of the mediastinal nodes is necessary

Patients with a peripheral clinical stage 1 don't need invasive confirmation unless Pet is positive

Regarding the M staging conventional imaging is an important component of clinical staging.

Whole body pet/ct detects occult intra and extrathoracic metastases (up to 20% of NSCLC)

Lernziele:

Regarding the M staging conventional imaging is an important component of clinical staging.

Whole body pet/ct detects occult intra and extrathoracic metastases (up to 20% of NSCLC)

Korrespondierender Autor: Bonomo L

Catholic University of Rome –„A. Gemelli“ Hospital, Department of Bioimaging and Radiological Sciences, Largo A. Gemelli 8, 00168 Rome

E-Mail: [e-mail]