Skip to main content Accessibility help
×
Hostname: page-component-77c89778f8-n9wrp Total loading time: 0 Render date: 2024-07-18T05:31:44.353Z Has data issue: false hasContentIssue false

5 - Staging of Lung Cancer

Published online by Cambridge University Press:  12 August 2009

Zelena A. Aziz
Affiliation:
Department of Radiology, St Bartholomew, and the Royal London Hospital, London, UK
Sujal R. Desai
Affiliation:
King's College Hospital, London
Get access

Summary

Introduction

Thoracic imaging is pivotal in the evaluation of patients with lung cancer. As with most other cancers, treatment options and outcomes are dependent on stage and cell type. Uniform criteria for reporting the findings of clinical and/or pathological evaluation are important in the initial management of patients with non-small cell lung cancer (NSCLC) and consequently all patients with NSCLC are typically staged before therapy according to the recommendations of the International Staging System for Lung Cancer. The treatment of choice for NSCLC, in the absence of disseminated disease is surgical resection. The primary aim of staging is thus to determine whether a tumour can be completely removed by surgery; clear surgical margins in resection specimens and the absence of tumour cells in resected lymph nodes being the prime determinants of local recurrence and survival. The aim of this chapter is to review the role of imaging in staging lung cancer, focusing on CT (currently, the main imaging modality used in staging) and MRI. For the sake of completeness the technique of position emission tomography (PET) will be referred to but this imaging modality is covered comprehensively elsewhere in this volume.

International Staging System (TNM Staging) for Lung Cancer

Before considering the role of imaging tests in staging, it is worth reminding the reader about the International Staging System for lung cancer.

Type
Chapter
Information
Lung Cancer , pp. 57 - 83
Publisher: Cambridge University Press
Print publication year: 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Mountain, C. F. (1997). Revisions in the International System for Staging Lung Cancer. Chest, 111(6), 1710–17.CrossRefGoogle ScholarPubMed
Park, B. J., Louie, O., Altorki, N. (2000). Staging and the surgical management of lung cancer. Radiol Clin North Am, 38(3), 545–61.CrossRefGoogle ScholarPubMed
Naruke, T., Tsuchiya, R., Kondo, H., et al. (2001). Prognosis and survival after resection for bronchogenic carcinoma based on the 1997 TNM-staging classification: the Japanese experience. Ann Thorac Surg, 71(6), 1759–64.CrossRefGoogle ScholarPubMed
Simon, G. R., Wagner, H. (2003). Small cell lung cancer. Chest, 123(1 Suppl), 259S–271S.CrossRefGoogle ScholarPubMed
Onitsuka, H., Tsukuda, M., Araki, A.et al. (1991). Differentiation of central lung tumor from postobstructive lobar collapse by rapid sequence computed tomography. J Thorac Imaging, 6(2), 28–31.CrossRefGoogle ScholarPubMed
Bourgouin, P. M., McLoud, T. C., Fitzgibbon, J. F., et al. (1991). Differentiation of bronchogenic carcinoma from postobstructive pneumonitis by magnetic resonance imaging: histopathologic correlation. J Thorac Imaging, 6(2), 22–7.CrossRefGoogle ScholarPubMed
Haramati, L. B., White, C. S. (2000). MR imaging of lung cancer. Magn Reson Imaging Clin N Am, 8(1), 43–57.Google ScholarPubMed
Epstein, D. M., Stephenson, L. W., Gefter, W. B., et al. (1986). Value of CT in the preoperative assessment of lung cancer: a survey of thoracic surgeons. Radiology, 161(2), 423–7.CrossRefGoogle ScholarPubMed
Lahde, S., Paivansalo, M., Rainio, P. (1991). CT for predicting the resectability of lung cancer. A prospective study. Acta Radiol, 32(6), 449–54.CrossRefGoogle ScholarPubMed
Lewis, J. W. Jr., Pearlberg, J. L., Beute, G. H., et al. (1990). Can computed tomography of the chest stage lung cancer? Yes and no. Ann Thorac Surg, 49(4), 591–5.CrossRefGoogle ScholarPubMed
Quint, L. E., Glazer, G. M., Orringer, M. B. (1987). Central lung masses: prediction with CT of need for pneumonectomy versus lobectomy. Radiology, 165(3), 735–8.CrossRefGoogle ScholarPubMed
Galetta, D., Cesario, A., Margaritora, S., et al. (2003). Enduring challenge in the treatment of nonsmall cell lung cancer with clinical stage IIIB: results of a trimodality approach. Ann Thorac Surg, 76(6), 1802–8.CrossRefGoogle ScholarPubMed
Ichinose, Y., Fukuyama, Y., Asoh, H., et al. (2003). Induction chemoradiotherapy and surgical resection for selected stage IIIB non-small-cell lung cancer. Ann Thorac Surg, 76(6), 1810–4.CrossRefGoogle ScholarPubMed
Burnett, R. J., Wood, D. E. (1999). The new lung cancer staging system: what does it mean?Surg Oncol Clin N Am, 8(2), 231–44.Google ScholarPubMed
Leong, S. S., Rocha Lima, C. M., Sherman, C. A., et al. (1999). The 1997 International Staging System for non-small cell lung cancer: have all the issues been addressed?Chest, 115(1), 242–8.CrossRefGoogle ScholarPubMed
Glazer, H. S., Kaiser, L. R., Anderson, D. J., et al. (1989). Indeterminate mediastinal invasion in bronchogenic carcinoma: CT evaluation. Radiology, 173, 37–42.CrossRefGoogle ScholarPubMed
Higashino, T., Ohno, Y., Takenaka, D., et al. (2005). Thin-section multiplanar reformats from multidetector-row CT data: utility for assessment of regional tumor extent in non-small cell lung cancer. Eur J Radiol, 56(1), 48–55.CrossRefGoogle ScholarPubMed
Lawler, L. P., Fishman, E. K. (2001). Multi-detector row CT of thoracic disease with emphasis on 3D volume rendering and CT angiography. RadioGraphics, 21, 1257–73.CrossRefGoogle ScholarPubMed
Boiselle, P. M. (2004). Staging of lung cancer with MDCT. In: U. J. Schoepf editor. Multi-detector Row CT of the Thorax. Berlin Heidelberg: Springer-Verlag, 205–14.
Musset, D., Grenier, P., Carette, M. F., et al. (1986). Primary lung cancer staging: prospective comparative study of MR imaging with CT. Radiology, 160(3), 607–11.CrossRefGoogle ScholarPubMed
Stiglbauer, R., Schurawitzki, H., Klepetko, W., et al. (1991). Contrast-enhanced MRI for the staging of bronchogenic carcinoma: comparison with CT and histopathologic staging–preliminary results. Clin Radiol, 44(5), 293–8.CrossRefGoogle ScholarPubMed
Mayr, B., Lenhard, M., Fink, U., et al. (1992). Preoperative evaluation of bronchogenic carcinoma: value of MR in T- and N-staging. Eur J Radiol, 14(3), 245–51.CrossRefGoogle Scholar
Ohno, Y., Sugimura, K., Hatabu, H. (2002). MR imaging of lung cancer. Eur J Radiol, 44(3), 172–81.CrossRefGoogle ScholarPubMed
White, C. S. (1996). MR evaluation of the pericardium and cardiac malignancies. Magn Reson Imaging Clin N Am, 4(2), 237–51.Google ScholarPubMed
Seo, J. S., Kim, Y. J., Choi, B. W., et al. (2005). Usefulness of magnetic resonance imaging for evaluation of cardiovascular invasion: evaluation of sliding motion between thoracic mass and adjacent structures on cine MR images. J Magn Reson Imaging, 22(2), 234–41.CrossRefGoogle ScholarPubMed
Mountain, C. F., Dresler, C. M. (1997). Regional lymph node classification for lung cancer staging. Chest, 111(6), 1718–23.CrossRefGoogle ScholarPubMed
Andre, F., Grunenwald, D., Pignon, J. P., et al. (2000). Survival of patients with resected N2 non-small-cell lung cancer: evidence for a subclassification and implications. J Clin Oncol, 18(16), 2981–9.CrossRefGoogle ScholarPubMed
Toloza, E. M., Harpole, L., McCrory, D. C. (2003). Noninvasive staging of non-small cell lung cancer: a review of the current evidence. Chest, 123(1 Suppl), 137S–146S.CrossRefGoogle ScholarPubMed
Buy, J. N., Ghossain, M. A., Poirson, F., et al. (1988). Computed tomography of mediastinal lymph nodes in nonsmall cell lung cancer. A new approach based on the lymphatic pathway of tumor spread. J Comput Assist Tomogr, 12(4), 545–52.CrossRefGoogle ScholarPubMed
Glazer, G. M., Orringer, M. B., Chenevert, T. L., et al. (1988). Mediastinal lymph nodes: relaxation time/pathologic correlation and implications in staging of lung cancer with MR imaging. Radiology, 168, 429–31.CrossRefGoogle ScholarPubMed
Anzai, Y., Blackwell, K. E., Hirschowitz, S. L., et al. (1994). Initial clinical experience with dextran-coated superparamagnetic iron oxide for detection of lymph node metastases in patients with head and neck cancer. Radiology, 192(3), 709–15.CrossRefGoogle ScholarPubMed
Bellin, M. F., Beigelman, C., Precetti-Morel, S. (2000). Iron oxide-enhanced MR lymphography: initial experience. Eur J Radiol, 34(3), 257–64.CrossRefGoogle ScholarPubMed
Wiersema, M., Edell, E., Midthun, D. (2002). Prospective comparison of transbronchial needle aspirate (TBNA) and endosonography gioded biopsy (EUS-FNA) of mediastinal lymph nodes in patients with known or suspected nonsmall cell lung cancer. Gastrointest. Endosc., 55, 115.Google Scholar
Fritscher-Ravens, A., Davidson, B. L., Hauber, H. P., et al. (2003). Endoscopic ultrasound, positron emission tomography, and computerized tomography for lung cancer. Am J Respir Crit Care Med, 168(11), 1293–7.CrossRefGoogle ScholarPubMed
Eloubeidi, M. A., Cerfolio, R. J., Chen, V. K., et al. (2005). Endoscopic ultrasound-guided fine needle aspiration of mediastinal lymph node in patients with suspected lung cancer after positron emission tomography and computed tomography scans. Ann Thorac Surg, 79(1), 263–8.CrossRefGoogle ScholarPubMed
Rintoul, R. C., Skwarski, K. M., Murchison, J. T., et al. (2005). Endobronchial and endoscopic ultrasound-guided real-time fine-needle aspiration for mediastinal staging. Eur Respir J, 25(3), 416–21.CrossRefGoogle ScholarPubMed
Wallace, M. B., Silvestri, G. A., Sahai, A. V., et al. (2001). Endoscopic ultrasound-guided fine needle aspiration for staging patients with carcinoma of the lung. Ann Thorac Surg, 72(6), 1861–7.CrossRefGoogle ScholarPubMed
LeBlanc, J., Devereaux, B. M., Imperiale, T. F., et al. (2004). Endoscopic Ultrasound in Non-Small Cell Lung Cancer and Negative Mediastinum on Computed Tomography. Am J Respir Crit Care Med, 171, 177–82.CrossRefGoogle ScholarPubMed
Silvestri, G. A., Hoffman, B., Reed, C. E. (2003). One from column A: choosing between CT, positron emission tomography, endoscopic ultrasound with fine-needle aspiration, transbronchial needle aspiration, thoracoscopy, mediastinoscopy, and mediastinotomy for staging lung cancer. Chest, 123(2), 333–5.CrossRefGoogle ScholarPubMed
Quint, L. E., Tummala, S., Brisson, L. J., et al. (1996). Distribution of distant metastases from newly diagnosed non-small cell lung cancer. Ann Thorac Surg, 62(1), 246–50.CrossRefGoogle ScholarPubMed
Ratto, G. B., Piacenza, G., Frola, C., et al. (1991). Chest wall involvement by lung cancer: computed tomographic detection and results of operation. Ann Thorac Surg, 51(2), 182–8.CrossRefGoogle ScholarPubMed
Scott, I. R., Muller, N. L., Miller, R. R., et al. (1988). Resectable stage III lung cancer: CT, surgical, and pathologic correlation. Radiology, 166(1 Pt 1), 75–9.CrossRefGoogle ScholarPubMed
Pennes, D. R., Glazer, G. M., Wimbish, K. J., et al. (1985). Chest wall invasion by lung cancer: limitations of CT evaluation. AJR Am J Roentgenol, 144(3), 507–11.CrossRefGoogle ScholarPubMed
Glazer, H. S., Duncan-Meyer, J., Aronberg, D. J., et al. (1985). Pleural and chest wall invasion in bronchogenic carcinoma: CT evaluation. Radiology, 157(1), 191–4.CrossRefGoogle ScholarPubMed
Pearlberg, J. L., Sandler, M. A., Beute, G. H., et al. (1987). Limitations of CT in evaluation of neoplasms involving chest wall. J Comput Assist Tomogr, 11(2), 290–3.CrossRefGoogle ScholarPubMed
Murata, K., Takahashi, M., Mori, M., et al. (1994). Chest wall and mediastinal invasion by lung cancer: evaluation with multisection expiratory dynamic CT. Radiology, 191(1), 251–5.CrossRefGoogle ScholarPubMed
Sakai, S., Murayama, S., Murakami, J., et al. (1997). Bronchogenic carcinoma invasion of the chest wall: evaluation with dynamic cine MRI during breathing. J Comput Assist Tomogr, 21(4), 595–600.CrossRefGoogle ScholarPubMed
Johnson, D. H., Hainsworth, J. D., Greco, F. A. (1982). Pancoast's syndrome and small cell lung cancer. Chest, 82(5), 602–6.CrossRefGoogle ScholarPubMed
Paulson, D. L. (1975). Carcinomas in the superior pulmonary sulcus. J Thorac Cardiovasc Surg, 70(6), 1095–104.Google ScholarPubMed
Detterbeck, F. C., Jones, D. R., Kernstine, K. H., et al. (2003). Lung cancer. Special treatment issues. Chest, 123(1 Suppl), 244S–258S.CrossRefGoogle ScholarPubMed
O'Connell, R. S., McLoud, T. C., Wilkins, E. W. (1983). Superior sulcus tumor: radiographic diagnosis and workup. AJR Am J Roentgenol, 140(1), 25–30.CrossRefGoogle ScholarPubMed
Webb, W. R., Gatsonis, C., Zerhouni, E. A., et al. (1991). CT and MR imaging in staging non-small cell bronchogenic carcinoma: report of the Radiologic Diagnostic Oncology Group. Radiology, 178(3), 705–13.CrossRefGoogle Scholar
Gefter, W. B. (1990). Magnetic resonance imaging in the evaluation of lung cancer. Semin Roentgenol, 25(1), 73–84.CrossRefGoogle ScholarPubMed
Heelan, R. T., Demas, B. E., Caravelli, J. F., et al. (1989). Superior sulcus tumors: CT and MR imaging. Radiology, 170, 637–41.CrossRefGoogle ScholarPubMed
McLoud, T. C., Filion, R. B., Edelman, R. R., et al. (1989). MR imaging of superior sulcus carcinoma. J Comput Assist Tomogr, 13, 233–9.CrossRefGoogle ScholarPubMed
Muers, M. F. (1994). Preoperative screening for metastases in lung cancer. Thorax, 49(1), 1–2.CrossRefGoogle ScholarPubMed
Tanaka, K., Kubota, K., Kodama, T., et al. (1999). Extrathoracic staging is not necessary for non-small-cell lung cancer with clinical stage T1–2 N0. Ann Thorac Surg, 68(3), 1039–42.CrossRefGoogle Scholar
Silvestri, G. A., Littenberg, B., Colice, G. L. (1995). The clinical evaluation for detecting metastatic lung cancer. A meta-analysis. Am J Respir Crit Care Med, 152(1), 225–30.CrossRefGoogle ScholarPubMed
Reed, C. E., Harpole, D. H., Posther, K. E., et al. (2003). Results of the American College of Surgeons Oncology Group Z0050 trial: the utility of positron emission tomography in staging potentially operable non-small cell lung cancer. J Thorac Cardiovasc Surg, 126(6), 1943–51.CrossRefGoogle ScholarPubMed
Oliver, T. W. Jr, Bernardino, M. E., Miller, J. I., et al. (1984). Isolated adrenal masses in nonsmall-cell bronchogenic carcinoma. Radiology, 153(1), 217–8.CrossRefGoogle ScholarPubMed
Pagani, J. J. (1984). Non-small cell lung carcinoma adrenal metastases. Computed tomography and percutaneous needle biopsy in their diagnosis. Cancer, 53(5), 1058–60.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Pagani, J. J. (1983). Normal adrenal glands in small cell lung carcinoma: CT-guided biopsy. AJR Am J Roentgenol, 140(5), 949–51.CrossRefGoogle ScholarPubMed
Boland, G. W., Lee, M. J., Gazelle, G. S., et al. (1998). Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR Am J Roentgenol, 171(1), 201–4.CrossRefGoogle ScholarPubMed
Pena, C. S., Boland, G. W., Hahn, P. F., et al. (2000). Characterization of indeterminate (lipid-poor) adrenal masses: use of washout characteristics at contrast-enhanced CT. Radiology, 217(3), 798–802.CrossRefGoogle ScholarPubMed
Boland, G. W., Hahn, P. F., Pena, C., et al. (1997). Adrenal masses: characterization with delayed contrast-enhanced CT. Radiology, 202(3), 693–6.CrossRefGoogle ScholarPubMed
Korobkin, M., Lombardi, T. J., Aisen, A. M., et al. (1995). Characterization of adrenal masses with chemical shift and gadolinium-enhanced MR imaging. Radiology, 197(2), 411–18.CrossRefGoogle ScholarPubMed
Baker, M. E., Pelley, R. (1995). Hepatic metastases: basic principles and implications for radiologists. Radiology, 197(2), 329–37.CrossRefGoogle ScholarPubMed
Hillers, T. K., Sauve, M. D., Guyatt, G. H. (1994). Analysis of published studies on the detection of extrathoracic metastases in patients presumed to have operable non-small cell lung cancer. Thorax, 49(1), 14–19.CrossRefGoogle ScholarPubMed
del Frate, C., Bazzocchi, M., Mortele, K. J., et al. (2002). Detection of liver metastases: comparison of gadobenate dimeglumine-enhanced and ferumoxides-enhanced MR imaging examinations. Radiology, 225(3), 766–72.CrossRefGoogle ScholarPubMed
Earnest, F., Ryu, J. H., Miller, G. M., et al. (1999). Suspected non-small cell lung cancer: incidence of occult brain and skeletal metastases and effectiveness of imaging for detection–pilot study. Radiology, 211(1), 137–45.CrossRefGoogle ScholarPubMed
Patchell, R. A., Tibbs, P. A., Walsh, J. W., et al. (1990). A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med, 322(8), 494–500.CrossRefGoogle Scholar
Colice, G. L., Birkmeyer, J. D., Black, W. C., et al. (1995). Cost-effectiveness of head CT in patients with lung cancer without clinical evidence of metastases. Chest, 108(5), 1264–71.CrossRefGoogle ScholarPubMed
Figlin, R. A., Piantadosi, S., Feld, R. (1988). Intracranial recurrence of carcinoma after complete surgical resection of stage I, II, and III non-small-cell lung cancer. N Engl J Med, 318(20), 1300–5.CrossRefGoogle Scholar
Robnett, T. J., Machtay, M., Stevenson, J. P., et al. (2001). Factors affecting the risk of brain metastases after definitive chemoradiation for locally advanced non-small-cell lung carcinoma. J Clin Oncol, 19(5), 1344–9.CrossRefGoogle ScholarPubMed
Yokoi, K., Kamiya, N., Matsuguma, H., et al. (1999). Detection of brain metastasis in potentially operable non-small cell lung cancer: a comparison of CT and MRI. Chest, 115(3), 714–9.CrossRefGoogle ScholarPubMed
Pretreatment evaluation of non-small-cell lung cancer. The American Thoracic Society and The European Respiratory Society. (1997). Am J Respir Crit Care Med, 156(1), 320–32.CrossRef
Erasmus, J. J., Truong, M. T., Munden, R. F. (2005). CT, MR, and PET imaging in staging of non-small-cell lung cancer. Semin Roentgenol, 40(2), 126–42.CrossRefGoogle ScholarPubMed
Pfister, D. G., Johnson, D. H., Azzoli, C. G., et al. (2004). American Society of Clinical Oncology treatment of unresectable non-small-cell lung cancer guideline: update 2003. J Clin Oncol, 22(2), 330–53.CrossRefGoogle Scholar
Davis, P. C., Hudgins, P. A., Peterman, S. B., et al. (1991). Diagnosis of cerebral metastases: double-dose delayed CT vs contrast-enhanced MR imaging. AJNR Am J Neuroradiol, 12(2), 293–300.Google ScholarPubMed
Ichinose, Y., Hara, N., Ohta, M., et al. (1989). Preoperative examination to detect distant metastasis is not advocated for asymptomatic patients with stages 1 and 2 non-small cell lung cancer. Preoperative examination for lung cancer. Chest, 96(5), 1104–09.CrossRefGoogle Scholar
Bury, T., Barreto, A., Daenen, F., et al. (1998). Fluorine-18 deoxyglucose positron emission tomography for the detection of bone metastases in patients with non-small cell lung cancer. Eur J Nucl Med, 25(9), 1244–7.CrossRefGoogle ScholarPubMed
Hsia, T. C., Shen, Y. Y., Yen, R. F., et al. (2002). Comparing whole body 18F-2-deoxyglucose positron emission tomography and technetium-99m methylene diophosphate bone scan to detect bone metastases in patients with non-small cell lung cancer. Neoplasma, 49(4), 267–71.Google ScholarPubMed
The Guideline Development Group. The Diagnosis and Treatment of Lung Cancer. (2005). 12–13. The National Institute of Clinical Excellence.
Pass, H. I. (2005). Mediastinal staging 2005: pictures, scopes, and scalpels. Semin Oncol, 32(3), 269–78.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Staging of Lung Cancer
    • By Zelena A. Aziz, Department of Radiology, St Bartholomew, and the Royal London Hospital, London, UK
  • Edited by Sujal R. Desai
  • Book: Lung Cancer
  • Online publication: 12 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545351.007
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Staging of Lung Cancer
    • By Zelena A. Aziz, Department of Radiology, St Bartholomew, and the Royal London Hospital, London, UK
  • Edited by Sujal R. Desai
  • Book: Lung Cancer
  • Online publication: 12 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545351.007
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Staging of Lung Cancer
    • By Zelena A. Aziz, Department of Radiology, St Bartholomew, and the Royal London Hospital, London, UK
  • Edited by Sujal R. Desai
  • Book: Lung Cancer
  • Online publication: 12 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545351.007
Available formats
×