Elsevier

PET Clinics

Volume 13, Issue 1, January 2018, Pages 1-10
PET Clinics

Staging of Non–Small-Cell Lung Cancer

https://doi.org/10.1016/j.cpet.2017.09.004Get rights and content

Section snippets

Key points

  • The International Association for the Study of Lung Cancer has reevaluated the staging system for lung cancer, reviewing data from more than 100,000 patients with lung cancer.

  • There are some changes in how T and M status are classified compared with the work completed in 2009.

  • In addition, a major reworking of the classification of adenocarcinomas occurred in 2011.

TNM classification

The International Association for the Study of Lung Cancer has reevaluated the staging system for lung cancer. Their analysis reviewed data derived from more than 100,000 patients with lung cancer. There are some changes in how T and M status are classified compared with the work completed in 2009. In addition, a major reworking of the classification of adenocarcinomas occurred in 2011. It is important that medical imaging reports reflect the new TNM (Tumour, Node, Metastasis) classifications.

T status

The International Association for the Study of Lung Cancer has recognized the impact of screening and thinly sliced computed tomography (CT) scans on the types of lung cancer presenting for management. There has been an increasing number of early lung cancers detected. Careful evaluation of small lesions was undertaken to try to tease out differences in outcomes seen in T1 tumors (≤3 cm in diameter).

There is increasing recognition that fine cut CT characteristics of a lung nodule are important.

Primary tumor

  • Tx = The primary tumor cannot be assessed, or tumor is proven by the presence of malignant cells in sputum or bronchial washings but cannot be visualized by imaging or bronchoscopy.

  • T0 = No objective evidence of a primary tumor.

  • Tis = Carcinoma in situ.

T1 is subject to subclassification, but is a parenchymal lesion (surrounded by lung or visceral pleura) equal to or less than 3 cm in maximal dimension, without bronchoscopic invasion of the main bronchus.

T1(mi) is a new classification that

Nodal disease

  • Nx: Regional lymph nodes cannot be assessed.

  • N0: No regional lymph node metastasis.

  • N1: Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension.

  • N2: Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s).

  • N3: Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s).

Distant Metastases
  1. M0: No distant metastasis.

  2. M1: Distant metastasis present.

Staging of newly diagnosed non–small-cell lung cancer

To provide uniform datasets for analysis, trial entry and to attempt to give prognostic information, the TNM classifications for an individual patient are then combined together into an overall “stage.” The new stage grouping are listed in Table 1.4

Comments

  • 1.

    It is likely that collaborative work like this will continue, and tumor parameters may move in or out of staging systems; academic centers interested in outcomes analysis should record raw data descriptors (such as tumor size in centimeters, number of nodes resected and number of nodes involved) in their databases rather than the TNM status alone. This would allow reanalysis of data using new classifications as they are adopted.

  • 2.

    Recognizing that there can be additional peritumoral inflammatory

The role of PET with fludeoxyglucose F 18 computed tomography scanning in staging patients with lung cancer

It has been shown that FDG PET CT scanning is better than CT scanning alone in determining nodal status and detecting occult metastatic disease than a contrast-enhanced CT scan5 or a bone scan.6 The timely detection of metastatic disease is by far and away the most important task when faced with a newly diagnosed lung cancer. Most patients with metastatic disease are not suitable for loco regional therapy with curative intent (Fig. 3).

It is now understood that osseous metastases establish

Summary

The staging of lung cancer serves 2 purposes. First, it attempts to classify patients into groups where particular treatments are appropriate. Second, staging has an important role in defining patient groups based on expected prognosis to allow design of clinical trials to test new therapies. The eighth edition of the International Association for the Study of Lung Cancer staging system deals with the issues raised by screening with fine cut CT scanning. Each phase of staging is a legitimate

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Disclosures: None.

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