CT and MR imaging in staging non-small cell bronchogenic carcinoma: report of the Radiologic Diagnostic Oncology Group.

Webb, W. Richard; Gatsonis, Constantine; Zerhouni, Elias A.; Heelan, Robert T.; Glazer, G M; Francis, Isaac R.; McNeil, Barbara J.

doi:10.1148/radiology.178.3.1847239

Cited by 504 publications

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“…It also alerts the surgeon to the presence of anatomical anomalies. No significant difference has been found between the ability of CT and MRI to detect N2 or N3 mediastinal metastases [98]. The combination of respiratory movement artefact and poorer spatial resolution [47] inherent with MRI can mean that small discrete nodes as seen on CT can appear as a larger, indistinct, single nodal mass on MRI, leading to the erroneous diagnosis of nodal enlargement.…”

Section: Nodal Statusmentioning

confidence: 99%

Diagnostic imaging of lung cancer

Hollings¹,

Shaw²

2002

Eur Respir J

112

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Carcinoma of the bronchus is the most common malignancy in the Western world. It is also the leading cause of cancer-related death accounting for 32% of all cancer deaths in males and 25% in females [1]. In the USA it causes more deaths than cancers of the colon, breast and prostate combined [2]. Disappointingly, in a recent UK survey of improvements in cancer survival [3], carcinoma of the bronchus showed the smallest percentage reduction in the number of deaths avoided between 1981-1990 (0.2%). This compares badly with breast (11% reduction) and melanoma (32%). The overall 5-yr survival for lung cancer diagnosed between 1986-1990 was only 5.3% (against 66% for breast and 76% for melanoma). It is on this background that the radiologist remains actively employed in the detection, diagnosis, staging and review of this common malignancy.

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Section: Nodal Statusmentioning

confidence: 99%

Diagnostic imaging of lung cancer

Hollings¹,

Shaw²

2002

Eur Respir J

112

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“…For lung cancer, radiologists still only consider superior sulcus tumour (Pancoast's tumour) and assessment of possible invasion of the spinal cord canal as indications for chest MRI. Despite major advances in MRI techniques, these indications have not changed significantly since 1991 [2]. The lung remains a challenge for MRI, but this method provides excellent tissue differentiation, and new sequences have increased the temporal resolution [3], expanding the use of MRI beyond its traditional applications.…”

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confidence: 99%

MRI in lung cancer: a pictorial essay

Hochhegger

Marchiori²,

Sedlaczek³

et al. 2011

BJR

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ABSTRACT. Imaging studies play a critical role in the diagnosis and staging of lung cancer. CT and 18-fluorodeoxyglucose positron emission tomography CT (PET/CT) are widely and routinely used for staging and assessment of treatment response. Many radiologists still use MRI only for the assessment of superior sulcus tumours, and in cases where invasion of the spinal cord canal is suspected. MRI can detect and stage lung cancer, and this method could be an excellent alternative to CT or PET/CT in the investigation of lung malignancies and other diseases. This pictorial essay discusses the use of MRI in the investigation of lung cancer. . The lung remains a challenge for MRI, but this method provides excellent tissue differentiation, and new sequences have increased the temporal resolution [3], expanding the use of MRI beyond its traditional applications. MRI can currently be used for establishing tumour node metastasis (TNM) staging, lung cancer screening and assessing lung nodules for likelihood of being benign or malignant [3]. This pictorial essay discusses the use of MRI in the diagnosis and staging of lung cancer. MRI for detection and characterisation of pulmonary nodulesMultidetector CT (MDCT) is routinely used to confirm and characterise lung lesions [1]. It is a very sensitive method for the detection of pulmonary nodules, and is considered the gold standard for detection of these lesions. The sensitivity of MRI for nodules of 5 to 11 mm is between 85% and 95% [4]. Although MDCT can depict nodules as small as 1 or 2 mm, immediate action is recommended only for lesions larger than 7 or 8 mm, depending on the lung cancer risk stratification. Followup to assess growth pattern is recommended for lesions smaller than 7 mm [5]. Koyama et al [6] reported that non-contrast enhanced pulmonary MRI can effectively detect malignant nodules as thin-section MDCT (Figure 1). The overall detection rate of nodules in each MRI sequence (82.5%) was significantly lower than that of MDCT (97.0%, p,0.05), however detection rates were not significantly different for malignant nodules (p.0.05) (Figure 2). Establishing clinical TNM stageThe overall agreement of clinical TNM (cTNM) staging established by CT compared with post-operative pathological TNM (pTNM) is not significantly better than 50%. Obviously, this comparison does not take into account cases in which the cTNM contraindicates surgery, as it does for the majority of cases. CT and PET-CT are currently the modalities recommended for assessing lung cancer if radical treatment (surgery or other therapeutic modality with curative intent) is suggested [1]. However, the capabilities of MRI have not yet been properly explored. MRI assessment of T-classificationThe T-stage of a tumour is the primary determinant of its resectability [7]. Evaluation of the primary tumour includes an assessment of its size, and the presence and extent of mediastinal or chest wall involvement. Of particular importance is the distinction between T3 and T4 tumours [7]. The definition of a T3 lesion i...

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“…The reported sensitiv ity of mediastinal lymph node staging by CT scan is ap proximately 60-80% [4, 9,13,19]. It is to be expected that modern CT scanning techniques, with the addition of intra venous contrast studies, will indicate whether a patient could benefit from a cervical mediastinoscopy or a para sternal procedure [7,16].…”

Section: Discussionmentioning

confidence: 99%

The value of parasternal mediastinoscopy in staging bronchial carcinoma

Barendregt

Deleu²,

Joosten³

et al. 1995

European Journal of Cardio-Thoracic Surgery

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Abstract. Computed tomography (CT) is the non-invasive staging procedure of choice for assessment of metas tasis to mediastinal lymph nodes in patients with bronchial carcinoma. Cervical mediastinoscopy can provide his tologic evidence of mediastinal spread to the peritracheal, tracheobronchial and subcarinal lymph nodes. Subaortic and para-aortic nodes cannot be sampled via this route. The present study was performed to assess the staging value of the parasternal mediastinoscopy as a separate entity. Cervical and parasternal mediastinoscopy was performed in 37 patients with a proven diagnosis of non-small cell carcinoma of the left upper lobe. In 16 pa tients lymph node or tumor tissue could be biopsied via the parasternal route, in 21 patients no parasternal bi opsy was taken. Of the 16 cases with biopsies, only one was positive (6%). Histologic examination of lymph node biopsy tissue was false negative in one other patient (6%). Of the 21 patients without biopsies taken during par asternal mediastinoscopy, three (14%) had proven lymphogenic spread to the subaortic and para-aortic nodes, detected at thoracotomy. The parasternal procedure changed treatment in only one patient (3%). Diagnostic sen sitivity was 20%. It is concluded that parasternal mediastinoscopy should not be used as a routine staging proce dure in patients with left upper lobe lung cancer. [Eur J Cardio-thorac Surg (1995) 9: 655-658] Key words: Parasternal -Mediastinoscopy -Lung cancerThe value of mediastinoscopy in the preoperative assessment of bronchial carcinoma is a subject of ongoing dis cussion. Cervical mediastinoscopy should be used for stag ing in the case of a so-called positive computed tomogra phy (CT) scan (mediastinal lymph nodes of 1.5 cm diam eter or larger, or a group of nodes each 1.0 cm or larger) [4J. Histologic evidence of mediastinal metastasis is man datory in all cases of enlarged nodes on CT scan.The value of parasternal (anterior) mediastinoscopy or mediastinotomy has been discussed in only a few recent publications [1, 4, 5,8,11,14]. In many instances no dif ference is made between the staging value of the cervical and the parasternal procedure. Due to the route of lympho genic spread, the parasternal mediastinoscopy is supposed to be important in the preoperative assessment of left upper lobe tumors [3,10,15]. The benefit of cervical mediasti noscopy is limited to patients with central mediastinal in volvement. Parasternal mediastinotomy is an alternative procedure, but is apparently more invasive than mediasti noscopy. The extended cervical mediastinoscopy, as ad vocated by Ginsberg, is not practised by many surgeons [1]. In some institutes the attitude towards mediastinos copy in general, and towards parasternal mediastinoscopy in particular, appears to have changed. This is partly due to the development of improved CT imaging techniques, which show mediastinal structures with a higher defini tion than 5 or 10 years ago, In order to reassess the value of the staging of lympho genic spread of bronchial carcinoma b...

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CT and MR imaging in staging non-small cell bronchogenic carcinoma: report of the Radiologic Diagnostic Oncology Group.

Cited by 504 publications

References 0 publications

Diagnostic imaging of lung cancer

Diagnostic imaging of lung cancer

MRI in lung cancer: a pictorial essay

The value of parasternal mediastinoscopy in staging bronchial carcinoma

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