The new 7th edition of the TNM classification system features a number of revisions, including subdivision of tumor categories on the basis of size, differentiation between local intra thoracic and distant metastatic disease, recategorization of malignant pleural or pericardial disease etc, on the basis of evidence from a significantly larger worldwide data base that has been subjected to extensive validation which attempts to better correlate disease with prognostic value and treatment strategy.
CT evaluation and staging of lung cancer can determine prognosis and treatment. There are two main types: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC is staged using the TNM system to describe tumor size (T), lymph node involvement (N), and metastases (M). Higher TNM stages indicate less favorable prognoses. SCLC is generally staged as limited disease, confined to one lung, or extensive disease with distant metastases. Accurate staging helps guide treatment decisions.
LUNG CANCER remains the leading cause of cancer-related mortality in men and women in the United States, accounting for over 157,000 deaths annually.Despite advances in imaging, lung cancer is often detected when the disease has spread from the primary tumour to regional lymph nodes or distant sites. Appropriate therapy is dependent on accurate staging to identify those patients who are surgical candidates and those patients for whom chemotherapy and radiation therapy is indicated.
In this review, the current staging system for lung cancer is discussed, along with practical imaging approaches.
the upcoming 8th edition of TNM staging in lung cancer will be published soon. what we need to know about TNM , how it was developed and why? how we can improve our practice for suspected lung cancer patients
8th Edition of the TNM Classification for Lung CancerMauricio Lema
The International Association for the Study of Lung Cancer proposed changes to the TNM classification system for lung cancer in its 8th edition:
- The T descriptor was modified so that tumor size increases in 1 cm increments from T1a to T2b rather than combining sizes.
- Exploratory subgrouping was proposed for N descriptors to distinguish single from multiple lymph node metastases in the future.
- The M descriptor was modified to separate M1 into M1a, M1b for single extra-thoracic metastases, and M1c for multiple extra-thoracic metastases.
- The changes aim to provide more detailed staging information to guide therapy decisions for lung cancer patients.
This document discusses the management of non-small cell lung cancer. It outlines the various treatment options depending on the stage of cancer, including surgery for early stages, radiation therapy, chemotherapy, and stereotactic body radiotherapy. It provides details on surgical procedures, radiation techniques, outcomes of stereotactic body radiotherapy, and the use of concurrent chemotherapy and radiation for locally advanced stages.
Management of Lung Cancer
By Dr Parneet Singh
1. Lung cancer is most commonly diagnosed at late stages. NSCLC stages at presentation range from 10% at stage I to 40% at stage IV.
2. Prognostic factors include patient performance status, weight loss, age, pulmonary function tests, tumor stage and molecular markers, completeness of resection, addition of chemotherapy and radiotherapy.
3. Treatment depends on stage - surgery or SBRT for stage I-II, chemotherapy and radiotherapy for stage III, chemotherapy and radiotherapy for consolidation or palliation in stage IV. Surgery provides the best chance for cure in early stages.
Christopher Azzoli, M.D., Assistant Member, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center: Current Modalities in the Treatment of Lung Cancer
Presented at New Frontiers in the Management of Solid and Liquid Tumors hosted by the John Theurer Cancer Center at Hackensack University Medical Center. jtcancercenter.org/CME
CT evaluation and staging of lung cancer can determine prognosis and treatment. There are two main types: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC is staged using the TNM system to describe tumor size (T), lymph node involvement (N), and metastases (M). Higher TNM stages indicate less favorable prognoses. SCLC is generally staged as limited disease, confined to one lung, or extensive disease with distant metastases. Accurate staging helps guide treatment decisions.
LUNG CANCER remains the leading cause of cancer-related mortality in men and women in the United States, accounting for over 157,000 deaths annually.Despite advances in imaging, lung cancer is often detected when the disease has spread from the primary tumour to regional lymph nodes or distant sites. Appropriate therapy is dependent on accurate staging to identify those patients who are surgical candidates and those patients for whom chemotherapy and radiation therapy is indicated.
In this review, the current staging system for lung cancer is discussed, along with practical imaging approaches.
the upcoming 8th edition of TNM staging in lung cancer will be published soon. what we need to know about TNM , how it was developed and why? how we can improve our practice for suspected lung cancer patients
8th Edition of the TNM Classification for Lung CancerMauricio Lema
The International Association for the Study of Lung Cancer proposed changes to the TNM classification system for lung cancer in its 8th edition:
- The T descriptor was modified so that tumor size increases in 1 cm increments from T1a to T2b rather than combining sizes.
- Exploratory subgrouping was proposed for N descriptors to distinguish single from multiple lymph node metastases in the future.
- The M descriptor was modified to separate M1 into M1a, M1b for single extra-thoracic metastases, and M1c for multiple extra-thoracic metastases.
- The changes aim to provide more detailed staging information to guide therapy decisions for lung cancer patients.
This document discusses the management of non-small cell lung cancer. It outlines the various treatment options depending on the stage of cancer, including surgery for early stages, radiation therapy, chemotherapy, and stereotactic body radiotherapy. It provides details on surgical procedures, radiation techniques, outcomes of stereotactic body radiotherapy, and the use of concurrent chemotherapy and radiation for locally advanced stages.
Management of Lung Cancer
By Dr Parneet Singh
1. Lung cancer is most commonly diagnosed at late stages. NSCLC stages at presentation range from 10% at stage I to 40% at stage IV.
2. Prognostic factors include patient performance status, weight loss, age, pulmonary function tests, tumor stage and molecular markers, completeness of resection, addition of chemotherapy and radiotherapy.
3. Treatment depends on stage - surgery or SBRT for stage I-II, chemotherapy and radiotherapy for stage III, chemotherapy and radiotherapy for consolidation or palliation in stage IV. Surgery provides the best chance for cure in early stages.
Christopher Azzoli, M.D., Assistant Member, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center: Current Modalities in the Treatment of Lung Cancer
Presented at New Frontiers in the Management of Solid and Liquid Tumors hosted by the John Theurer Cancer Center at Hackensack University Medical Center. jtcancercenter.org/CME
Conversatorio con cirugía de tórax sobre NSCLC - 1/3Mauricio Lema
This document summarizes several conferences and presentations on topics related to non-small cell lung cancer (NSCLC). It outlines three conference sessions that will discuss early and locally-advanced NSCLC as well as metastatic disease. Targeted therapies and immunotherapy for metastatic NSCLC are mentioned. Breaking news is also noted about interdisciplinary meetings on systemic therapy for NSCLC. Details are provided on TNM classification changes for lung cancer staging in the 8th edition.
That's cool a rossi la classificazione tnm cosa cambia 24 settembre 2010 coolesanum
The document discusses changes to the 7th Edition of the TNM classification system for lung cancer. Key changes include subclassifying T1 and T2 tumors based on size, reclassifying some T2 and T4 tumors as higher stages, and subclassifying M1 metastases. Validation studies using large international databases showed the changes improved survival prediction compared to the 6th Edition. However, some criticisms note limitations like the databases' lack of data from all world regions and that the changes better predict prognosis than guide treatment decisions.
This document discusses lung cancer, including risk factors, types, staging, diagnosis, and treatment options. It notes that smoking is the primary risk factor, greatly increasing lifetime risk. The two main types are non-small cell lung cancer (NSCLC) and small cell lung cancer. Staging involves determining the size and spread of the tumor using imaging and lymph node involvement. Treatment depends on stage but commonly includes surgery for early stages and chemotherapy with or without radiation for later stages. Outcomes remain poor, especially for metastatic disease, but improved understanding of lung cancer has led to personalized treatment approaches.
This document summarizes colorectal cancer epidemiology, pathology, and prognostic factors. It discusses incidence and mortality rates, risk factors, molecular pathways, histological subtypes and grading, lymph node assessment, venous and perineural invasion detection, and resection margins. Key points include the importance of evaluating lymph nodes from within 3 cm of the tumor and using elastic stains to better detect clinically relevant venous invasion.
The document discusses different subgroups of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). It notes that around 75% of NSCLC cases do not have a known "driver" mutation, while around 10-15% have mutations in genes like EGFR, ALK, or ROS1. PD-L1 expression levels can further stratify NSCLC cases without drivers. The staging of lung cancer is discussed according to the TNM system, as well as treatments for different stages including surgery, chemotherapy, radiation, targeted therapies and immunotherapy.
This document provides information needed to treat lung cancer, including:
- Tissue diagnosis and accurate TNM/stage are essential to determine treatment strategies. Performance status and comorbidities should also be assessed.
- Staging procedures like CT, PET-CT, MRI and bone scans are used to detect metastatic disease and determine if a patient has early, locally advanced, or advanced lung cancer.
- Treatment depends on cancer type and stage. Options include surgery, chemotherapy, radiation, targeted therapy, immunotherapy and combinations based on tumor markers. The goal is customized treatment for each patient's unique cancer characteristics and health status.
This document discusses the TNM staging system for cervical cancer and treatment approaches based on stage. It notes that TNM is sufficient to guide cervical cancer therapy. Early stage (IA1-IIA1) non-bulky cancers less than 4cm are typically treated with surgery alone or radiation. Later stage or bulky cancers (IB2-IIIB) are treated with concurrent chemoradiation using cisplatin. Stage IVA is treated with palliative chemotherapy like cisplatin and paclitaxel.
This document discusses lung cancer treatment and recent advances. It begins with an introduction on lung cancer being the most common malignancy worldwide and a leading cause of cancer death. It then covers topics like incidence and prevalence rates, classification and pathology of lung cancer types (non-small cell vs. small cell), staging systems, risk factors, investigations, imaging, surgery, chemotherapy regimens for different stages, and prognosis factors. Key points emphasized are the rising rates of adenocarcinoma, importance of imaging and staging for determining treatment options, and multimodality therapy for locally advanced stages.
This document provides a case presentation and question regarding the next appropriate step in management for a patient. The case involves a 56-year-old man evaluated for weakness, dry eyes/mouth, and erectile dysfunction following treatment for limited-stage small cell lung cancer 3 months prior. On examination, the patient has ptosis, proximal weakness, absent reflexes that improve after brief exercise. The most likely diagnosis is myasthenia gravis.
Radiation therapy for early stage hodgkin’s lymphomaSandip Sarkar
This document discusses radiation therapy for early stage Hodgkin's lymphoma. It provides a brief history of treatment and developments. Key points include:
- Combined modality therapy with chemotherapy and radiation therapy is now the standard of care for early stage disease based on improved outcomes compared to radiation alone.
- For early stage favorable disease, the consensus is multi-agent chemotherapy for 2-4 cycles with involved field radiation therapy. For early stage unfavorable disease, 4 cycles of chemotherapy and radiation is recommended.
Evaluation and management of Stage III Non-Small Cell Carcinoma Lung including Radiotherapy planning. On a Radiation Oncologist Perspective. MD Radiotherapy discussion - CMC, Vellore
Echoendoscopic Lymph Node Staging in Lung Cancer: An endoscopic alternativeKue Lee
Echoendoscopic lymph node staging in lung cancer provides an endoscopic alternative to surgical staging that is minimally invasive, accurate, and prevents unnecessary surgeries. Combined endobronchial ultrasound and endoscopic ultrasound (EBUS/EUS) procedures sample lymph nodes and detect metastasis with a sensitivity of 91% and specificity of 96%, outperforming surgical staging. EBUS/EUS is now considered the new gold standard for mediastinal staging as it is safer, less costly, and more comprehensive than surgical staging alone.
REVIEW OF METHODS FOR DIAGNOSIS OF LUNG CANCERswankyshahir
This document discusses the diagnosis of lung cancer. It covers risk factors for lung cancer like smoking and air pollution. Screening methods are discussed, including low-dose CT screening which has been shown to decrease lung cancer mortality by 20% compared to chest x-rays. Diagnostic tools covered include sputum cytology, chest x-rays, CT scans, PET scans, bronchoscopy, biopsy and gene mutations associated with lung cancer like EGFR and KRAS. Early detection through low-dose CT screening and use of various diagnostic imaging and biopsy methods is key to improving outcomes for lung cancer patients.
This document summarizes information on lung cancer screening and diagnosis. It discusses findings from the National Lung Screening Trial which showed that low-dose CT screening reduced lung cancer mortality by 20% in high-risk patients aged 55-74 who were current or former heavy smokers. Risk factors for lung cancer are also reviewed, notably smoking which is responsible for over 90% of lung cancer deaths. The clinical presentation of lung cancer and methods for diagnosis including imaging, biopsy, histology, and molecular testing are described. The TNM staging system is explained along with descriptors for tumor size and lymph node involvement.
This document discusses head and neck PET/CT scans. It provides information on:
- The types of cancers that PET/CT scans are used for in the head and neck region.
- The superiority of PET/CT over CT and MRI for detecting lymph node involvement, distant metastases, and unknown primary cancers.
- The key applications of PET/CT including pretreatment staging, radiotherapy planning, monitoring treatment response, follow-up care, and detecting unknown primary cancers.
This document discusses treatment options for lung cancer, including surgery, radiation therapy, chemotherapy, targeted therapy, and palliative care. It describes the different types and stages of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), and provides details on standard treatment approaches based on cancer stage, including combinations of surgery, chemotherapy, and radiation therapy. Targeted therapies discussed include angiogenesis inhibitors like bevacizumab, and EGFR inhibitors like erlotinib and afatinib that target specific genetic mutations in NSCLC cells.
Multidisciplinary consensus statement on the clinical management of patient w...ssuser118306
This document presents a multidisciplinary consensus statement on the clinical management of patients with stage III non-small cell lung cancer (NSCLC) from several Spanish scientific societies. It discusses the heterogeneity of stage III NSCLC and the importance of accurate staging and multidisciplinary treatment planning. The summary provides guidelines on non-invasive and invasive staging techniques and recommends surgical staging when non-surgical methods are negative or non-conclusive to accurately determine tumor involvement and develop optimal treatment plans.
This document discusses lung cancer, specifically focusing on non-small cell lung cancer (NSCLC) and small cell lung cancer. It covers the epidemiology, risk factors, clinical presentation, pathology, staging, and imaging of lung cancer. The main points are:
- Cigarette smoking is the leading risk factor for lung cancer and increases the risk 20-30 times. NSCLC makes up 80% of cases and includes adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Small cell carcinoma accounts for the remaining 20% of cases.
- Symptoms of lung cancer are often nonspecific but may include cough, dyspnea, hemoptysis, and chest pain. Imaging plays an
Conversatorio con cirugía de tórax sobre NSCLC - 1/3Mauricio Lema
This document summarizes several conferences and presentations on topics related to non-small cell lung cancer (NSCLC). It outlines three conference sessions that will discuss early and locally-advanced NSCLC as well as metastatic disease. Targeted therapies and immunotherapy for metastatic NSCLC are mentioned. Breaking news is also noted about interdisciplinary meetings on systemic therapy for NSCLC. Details are provided on TNM classification changes for lung cancer staging in the 8th edition.
That's cool a rossi la classificazione tnm cosa cambia 24 settembre 2010 coolesanum
The document discusses changes to the 7th Edition of the TNM classification system for lung cancer. Key changes include subclassifying T1 and T2 tumors based on size, reclassifying some T2 and T4 tumors as higher stages, and subclassifying M1 metastases. Validation studies using large international databases showed the changes improved survival prediction compared to the 6th Edition. However, some criticisms note limitations like the databases' lack of data from all world regions and that the changes better predict prognosis than guide treatment decisions.
This document discusses lung cancer, including risk factors, types, staging, diagnosis, and treatment options. It notes that smoking is the primary risk factor, greatly increasing lifetime risk. The two main types are non-small cell lung cancer (NSCLC) and small cell lung cancer. Staging involves determining the size and spread of the tumor using imaging and lymph node involvement. Treatment depends on stage but commonly includes surgery for early stages and chemotherapy with or without radiation for later stages. Outcomes remain poor, especially for metastatic disease, but improved understanding of lung cancer has led to personalized treatment approaches.
This document summarizes colorectal cancer epidemiology, pathology, and prognostic factors. It discusses incidence and mortality rates, risk factors, molecular pathways, histological subtypes and grading, lymph node assessment, venous and perineural invasion detection, and resection margins. Key points include the importance of evaluating lymph nodes from within 3 cm of the tumor and using elastic stains to better detect clinically relevant venous invasion.
The document discusses different subgroups of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). It notes that around 75% of NSCLC cases do not have a known "driver" mutation, while around 10-15% have mutations in genes like EGFR, ALK, or ROS1. PD-L1 expression levels can further stratify NSCLC cases without drivers. The staging of lung cancer is discussed according to the TNM system, as well as treatments for different stages including surgery, chemotherapy, radiation, targeted therapies and immunotherapy.
This document provides information needed to treat lung cancer, including:
- Tissue diagnosis and accurate TNM/stage are essential to determine treatment strategies. Performance status and comorbidities should also be assessed.
- Staging procedures like CT, PET-CT, MRI and bone scans are used to detect metastatic disease and determine if a patient has early, locally advanced, or advanced lung cancer.
- Treatment depends on cancer type and stage. Options include surgery, chemotherapy, radiation, targeted therapy, immunotherapy and combinations based on tumor markers. The goal is customized treatment for each patient's unique cancer characteristics and health status.
This document discusses the TNM staging system for cervical cancer and treatment approaches based on stage. It notes that TNM is sufficient to guide cervical cancer therapy. Early stage (IA1-IIA1) non-bulky cancers less than 4cm are typically treated with surgery alone or radiation. Later stage or bulky cancers (IB2-IIIB) are treated with concurrent chemoradiation using cisplatin. Stage IVA is treated with palliative chemotherapy like cisplatin and paclitaxel.
This document discusses lung cancer treatment and recent advances. It begins with an introduction on lung cancer being the most common malignancy worldwide and a leading cause of cancer death. It then covers topics like incidence and prevalence rates, classification and pathology of lung cancer types (non-small cell vs. small cell), staging systems, risk factors, investigations, imaging, surgery, chemotherapy regimens for different stages, and prognosis factors. Key points emphasized are the rising rates of adenocarcinoma, importance of imaging and staging for determining treatment options, and multimodality therapy for locally advanced stages.
This document provides a case presentation and question regarding the next appropriate step in management for a patient. The case involves a 56-year-old man evaluated for weakness, dry eyes/mouth, and erectile dysfunction following treatment for limited-stage small cell lung cancer 3 months prior. On examination, the patient has ptosis, proximal weakness, absent reflexes that improve after brief exercise. The most likely diagnosis is myasthenia gravis.
Radiation therapy for early stage hodgkin’s lymphomaSandip Sarkar
This document discusses radiation therapy for early stage Hodgkin's lymphoma. It provides a brief history of treatment and developments. Key points include:
- Combined modality therapy with chemotherapy and radiation therapy is now the standard of care for early stage disease based on improved outcomes compared to radiation alone.
- For early stage favorable disease, the consensus is multi-agent chemotherapy for 2-4 cycles with involved field radiation therapy. For early stage unfavorable disease, 4 cycles of chemotherapy and radiation is recommended.
Evaluation and management of Stage III Non-Small Cell Carcinoma Lung including Radiotherapy planning. On a Radiation Oncologist Perspective. MD Radiotherapy discussion - CMC, Vellore
Echoendoscopic Lymph Node Staging in Lung Cancer: An endoscopic alternativeKue Lee
Echoendoscopic lymph node staging in lung cancer provides an endoscopic alternative to surgical staging that is minimally invasive, accurate, and prevents unnecessary surgeries. Combined endobronchial ultrasound and endoscopic ultrasound (EBUS/EUS) procedures sample lymph nodes and detect metastasis with a sensitivity of 91% and specificity of 96%, outperforming surgical staging. EBUS/EUS is now considered the new gold standard for mediastinal staging as it is safer, less costly, and more comprehensive than surgical staging alone.
REVIEW OF METHODS FOR DIAGNOSIS OF LUNG CANCERswankyshahir
This document discusses the diagnosis of lung cancer. It covers risk factors for lung cancer like smoking and air pollution. Screening methods are discussed, including low-dose CT screening which has been shown to decrease lung cancer mortality by 20% compared to chest x-rays. Diagnostic tools covered include sputum cytology, chest x-rays, CT scans, PET scans, bronchoscopy, biopsy and gene mutations associated with lung cancer like EGFR and KRAS. Early detection through low-dose CT screening and use of various diagnostic imaging and biopsy methods is key to improving outcomes for lung cancer patients.
This document summarizes information on lung cancer screening and diagnosis. It discusses findings from the National Lung Screening Trial which showed that low-dose CT screening reduced lung cancer mortality by 20% in high-risk patients aged 55-74 who were current or former heavy smokers. Risk factors for lung cancer are also reviewed, notably smoking which is responsible for over 90% of lung cancer deaths. The clinical presentation of lung cancer and methods for diagnosis including imaging, biopsy, histology, and molecular testing are described. The TNM staging system is explained along with descriptors for tumor size and lymph node involvement.
This document discusses head and neck PET/CT scans. It provides information on:
- The types of cancers that PET/CT scans are used for in the head and neck region.
- The superiority of PET/CT over CT and MRI for detecting lymph node involvement, distant metastases, and unknown primary cancers.
- The key applications of PET/CT including pretreatment staging, radiotherapy planning, monitoring treatment response, follow-up care, and detecting unknown primary cancers.
This document discusses treatment options for lung cancer, including surgery, radiation therapy, chemotherapy, targeted therapy, and palliative care. It describes the different types and stages of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), and provides details on standard treatment approaches based on cancer stage, including combinations of surgery, chemotherapy, and radiation therapy. Targeted therapies discussed include angiogenesis inhibitors like bevacizumab, and EGFR inhibitors like erlotinib and afatinib that target specific genetic mutations in NSCLC cells.
Multidisciplinary consensus statement on the clinical management of patient w...ssuser118306
This document presents a multidisciplinary consensus statement on the clinical management of patients with stage III non-small cell lung cancer (NSCLC) from several Spanish scientific societies. It discusses the heterogeneity of stage III NSCLC and the importance of accurate staging and multidisciplinary treatment planning. The summary provides guidelines on non-invasive and invasive staging techniques and recommends surgical staging when non-surgical methods are negative or non-conclusive to accurately determine tumor involvement and develop optimal treatment plans.
This document discusses lung cancer, specifically focusing on non-small cell lung cancer (NSCLC) and small cell lung cancer. It covers the epidemiology, risk factors, clinical presentation, pathology, staging, and imaging of lung cancer. The main points are:
- Cigarette smoking is the leading risk factor for lung cancer and increases the risk 20-30 times. NSCLC makes up 80% of cases and includes adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Small cell carcinoma accounts for the remaining 20% of cases.
- Symptoms of lung cancer are often nonspecific but may include cough, dyspnea, hemoptysis, and chest pain. Imaging plays an
This document discusses squamous cell carcinoma of the lung. Key points include:
- Squamous cell carcinoma accounts for 30-35% of lung cancers and is strongly associated with heavy smoking. It often presents as a central mass that obstructs bronchi.
- Pathology shows tumors that are white in color and invade the lung parenchyma and chest wall. Larger tumors develop necrosis.
- Radiographic features include collapsed lung segments, cavitary lesions, and pleural effusions. Endobronchial growth patterns are common.
1) Tuberculosis can mimic the clinical and radiological presentation of cardiac sarcoidosis, causing myocardial lesions and mediastinal lymphadenopathy in patients with sudden arrhythmias.
2) The study evaluated 10 patients showing these findings on cardiac MRI and found that 3 patients were diagnosed with tuberculosis based on biopsy results, while the remaining 7 patients were diagnosed as sarcoidosis or remained undiagnosed.
3) It is important for doctors to consider tuberculosis as a possible differential diagnosis for these symptoms, especially in areas where tuberculosis is common or in migrant populations, as the disease can affect the heart similarly to sarcoidosis.
Conversatorio con cirugía de tórax sobre NSCLC - 1/3 - Versión 2Mauricio Lema
This document outlines three conferences on topics related to non-small cell lung cancer (NSCLC). The first conference will discuss early-stage NSCLC and angiogenesis in metastatic NSCLC. The second will focus on locally-advanced NSCLC and targeted therapy for metastatic disease. The third conference controversies in oligometastatic NSCLC and immunotherapy for NSCLC. It also announces the beginning of interdisciplinary meetings on systemic therapy for NSCLC.
Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Litera...AnonIshanvi
Simultaneous presentation of two lymphatic haematological malignancies is extremely rare. Adequate and optimal diagnostic steps including various imaging techniques and histopathological biopsies are required unpin the exact diagnoses to be able to deliver the best management strategies
Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Litera...daranisaha
Simultaneous presentation of two lymphatic haematological malignancies is extremely rare. Adequate and optimal diagnostic steps including various imaging techniques and histopathological biopsies are required unpin the exact diagnoses to be able to deliver the best management strategies...
Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Litera...JohnJulie1
Simultaneous presentation of two lymphatic haematological malignancies is extremely rare. Adequate and optimal diagnostic steps including various imaging techniques and histopathological biopsies are required unpin the exact diagnoses to be able to deliver the best management strategies...
Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Litera...NainaAnon
This document presents a case report of a rare occurrence of simultaneous diffuse large B-cell lymphoma (DLBCL) and multiple myeloma in a 70-year-old man. Positron emission tomography/computed tomography (PET/CT) scanning revealed discrepancies in fluorodeoxyglucose (FDG) uptake between myelomatous bone lesions and an inguinal lymph node. Biopsy of the lymph node confirmed DLBCL. The case highlights the important role of PET/CT scanning in determining the optimal biopsy site when evaluating patients for potential dual hematological malignancies. PET/CT scanning can help guide diagnosis and treatment planning in these complex cases.
Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Litera...semualkaira
Simultaneous presentation of two lymphatic haematological malignancies is extremely rare. Adequate and optimal diagnostic steps including various imaging techniques and histopathological biopsies are required unpin the exact diagnoses to be able to deliver the best management strategies...
Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Litera...semualkaira
Simultaneous presentation of two lymphatic haematological malignancies is extremely rare. Adequate and optimal diagnostic steps including various imaging techniques and histopathological biopsies are required unpin the exact diagnoses to be able to deliver the best management strategies...
The simultaneous occurrence of two lymphatic malignancies in
one patient is extremely rare with an incidence rate of 1.4–6.5
cases/1,000,000 individuals [8]. Co-existence of MM and other
lymphoid malignancies like Chronic Lymphocytic Leukemia (CLL)
[9], MM and Hodgkin’s Disease (HD) [10], MM and Lympho
Plasmacytic Lymphoma (LPL) [11] has been reported. However,
there are less than 5 reported cases in PubMed of simultaneous
presentation of DLBCL and MM
Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Litera...EditorSara
This document presents a case report of a rare occurrence of simultaneous diffuse large B-cell lymphoma (DLBCL) and multiple myeloma in a 70-year-old male patient. Positron emission tomography/computed tomography (PET/CT) imaging revealed discrepancies in fluorodeoxyglucose (FDG) uptake between myelomatous bone lesions and an inguinal lymph node. Biopsy of the lymph node confirmed DLBCL. The case highlights the critical role of PET/CT in determining the optimal biopsy site and unraveling the dual pathology. It also discusses the rarity and complex treatment considerations of concurrent lymphoid malignancies.
Usefulness of Non-Enhanced 3-Dementional CT with Partial Maximum Intensity Pr...science journals
Computed Tomography (CT) with contrast material is often used for preoperative assessment and planning of embolotherapy in the treatment of Pulmonary Arteriovenous Malformations (PAVMs).
Can Lung Ultrasound in Patients with Fever of Unknown Origin Detect Early Sig...navasreni
The increasing interest in Lung Ultrasound (LUS) over the last years led to a great diffusion and better experience in using this technique, which became an essential tool for clinicians. During the current Coronavirus Disease 2019 (COVID-19) pandemic, LUS is being extensively applied to the evaluation and monitoring....
Can Lung Ultrasound in Patients with Fever of Unknown Origin Detect Early Sig...clinicsoncology
The increasing interest in Lung Ultrasound (LUS) over the last years led to a great diffusion and better experience in using this technique, which became an essential tool for clinicians. During the current Coronavirus Disease 2019 (COVID-19) pandemic
Can Lung Ultrasound in Patients with Fever of Unknown Origin Detect Early Sig...pateldrona
The increasing interest in Lung Ultrasound (LUS) over the last years led to a great diffusion and better experience in using this technique, which became an essential tool for clinicians. During the current Coronavirus Disease 2019 (COVID-19) pandemic, LUS is being extensively applied to the evaluation and monitoring....
Can Lung Ultrasound in Patients with Fever of Unknown Origin Detect Early Sig...georgemarini
The increasing interest in Lung Ultrasound (LUS) over the last years led to a great diffusion and better experience in using this technique, which became an essential tool for clinicians. During the current Coronavirus Disease 2019 (COVID-19) pandemic
Can Lung Ultrasound in Patients with Fever of Unknown Origin Detect Early Sig...AnonIshanvi
The increasing interest in Lung Ultrasound (LUS) over the last years led to a great diffusion and better experience in using this technique, which became an essential tool for clinicians. During the current Coronavirus Disease 2019 (COVID-19) pandemic, LUS is being extensively applied to the evaluation and monitoring....
Can Lung Ultrasound in Patients with Fever of Unknown Origin Detect Early Sig...komalicarol
In this case report we describe the detection of very early ultrasonographic signs of lung involvement in a patient who presented no clinical signs of Severe Acute Respiratory Syndrome
Coronavirus 2 (SARS-CoV-2) pneumonia, but who developed respiratory symptoms and tested
positive for SARS-CoV-2 infection 22 days later
Similar to Restaging of Bronchogenic Carcinoma Based on 7th Edition of TNM Classification - Using Integerated PET CT. (20)
Movement disorders: A complication of chronic hyperglycemia? A case reportApollo Hospitals
A 77-year-old man presented with bilateral choreic movements that had developed over the past month. He had a history of poorly controlled type 2 diabetes. At admission, he was found to have severe hyperglycemia without ketosis. A CT scan showed hyperdensity in the putamen and lenticular nucleus. Treatment with insulin, haloperidol, and glycemic control led to regression of the choreic movements within 4 days. Chorea secondary to nonketotic hyperglycemia is a rare complication of uncontrolled diabetes that is usually reversible with normalization of blood glucose levels and neuroleptic treatment. The pathophysiology is thought to involve metabolic disturbances from hyperglycemia impairing neurotransmission in basal ganglia structures and
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleApollo Hospitals
Malignant mixed mullerian tumors are very rare genital tumors. They are biphasic neoplasms composed of an admixture of malignant epithelial and mesenchymal elements. In descending order of frequency they originate in the uterus, ovaries, fallopian tubes, cervix and vagina. Also they arise denovo from peritoneum. They are highly aggressive and tend to occur in postmenopausal low parity women. Because of rarity, there is as such no treatment guidelines available. Multimodality treatment in the form of radical surgery followed by adjuvant chemotherapy or radiotherapy or combined chemoradiation gives a better prognosis & outcome. Two case reports of such tumors, one from ovary and other from penitoneum are presented along with the review of literature.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
This case report describes the successful treatment of an acardiac twin (TRAP sequence) via intra-fetal laser ablation of the umbilical vessels. The patient was a 26 year old pregnant woman at 18 weeks gestation with twins, one normal (Twin A) and one acardiac (Twin B). By 26 weeks, Twin A showed signs of cardiac failure so laser ablation was performed to interrupt blood flow from Twin B to A. This minimally invasive procedure used an Nd: YAG laser to coagulate the vessels under ultrasound guidance. The pregnancy continued successfully, with Twin A delivered via c-section at 35 weeks in good condition. This report demonstrates that intra-fetal laser ablation can safely
Improved Patient Satisfaction At Apollo – A Case StudyApollo Hospitals
1) Indraprastha Apollo Hospital utilized patient satisfaction surveys called Voice of Customer (VOC) tools to identify ways to improve various hospital departments and services.
2) Factors that contributed to an increasing trend in VOC scores over 1.5 years included leadership commitment to quality improvement, improved efficiency, superior clinical care, soft skills enhancement for staff, and improved patient information and complaint resolution.
3) Through consistent efforts such as staff training, improved processes, and addressing issues identified in VOC surveys, Apollo Hospitals achieved higher than target patient satisfaction scores, creating loyal patients with memorable hospital experiences.
Breast Cancer in Young Women and its Impact on Reproductive FunctionApollo Hospitals
Breast cancer is the most common cancer in women in developed countries. Chemotherapy for breast cancer is likely to negatively impact on reproductive function. We review current treatment; effects on reproductive function; breastfeeding and management of menopausal symptoms following breast cancer.
Turner syndrome (gonadal dysgenesis) is one of the most common chromosomal abnormalities occuring 1 in 2500 to 1 in 3000 live-born girls. It is an important cause of short stature in girls and primary amenorrhea in young women that is usually caused by loss of part or all of an X chromosome. This review briefly summarises the current knowledge about the syndrome and the management strategies.
Due to pregnancy thyroid economy is affected with changes in iodine metabolism, TBG and development of maternal goiter. The incidence of hypothyroidism in pregnancy is quite common with autoimmune hypothyroidism being the most important cause. Overt as well as subclinical hypothyroidism has a varied impact on maternal and neonatal outcome. After multiple studies also, routine screening in pregnancy for hypothyroidism can still not be recommended. Management mainly comprises of dosage adjustments as soon as pregnancy is diagnosed based on results of thyroid function tests. The aim should be to keep FT4 at the upper end of normal range.
Growth Hormone Deficiency (GHD) can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. Growth harmone (GH) therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.
Advances in the management of thalassemia have led to marked improvements in the life span and quality of life of children and young adults. This poses new challenges for the treating physicians. There is now increasing recognition that thalassemics have impaired bone health which is multifactorial in etiology. This paper aims to highlight the factors that predispose these patients to osteoporosis and suggests measures to minimise the impact on bone health.
A 34-year-old woman presented with accidental ingestion of mercury that was used in her household to preserve grains. She experienced abdominal radiopaque shadows on X-ray that cleared after two days. Mercury poisoning can result from inhalation, ingestion, or absorption and affects the neurological, gastrointestinal, and renal systems. Diagnosis involves determining exposure history and elevated mercury levels in blood and urine. Supportive treatment includes removal of contaminated materials, irrigation, activated charcoal, chelation agents, and hemodialysis in severe cases.
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Viral infections like HIV, hepatitis Band C virus pose a big risk to the contacts of individuals with high risk behaviour as well as to the attending health care workers. Blood, semen, vaginal and other potentially infectious materials can transmit the infection to the susceptible contacts. Universal precautions should be strictly implemented during clinical examination, laboratory work and surgical procedures to prevent transmission to the health care providers. Health care workers should receive vaccination for hepatitis B infection. An inadvertent exposure should be managed with proper first aid and infectivity of the source and severity of exposure should be assessed. Severity of exposure is based on the nature and area of exposed surface, mode of injury and volume of infective material. Post-exposure prophylaxis (PEP) should be started as soon as possible after a proper counseling about the effectiveness of post-exposure prophylaxis, side effects and risk of carrying the infection to his familial contacts and its prevention.
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Various drugs used to treat pemphigus can cause remission, but none can provide permanent remission as relapses are common. With the introduction of DCP in pemphigus in 1984, patients started being in prolonged/permanent remission. This study was done to compare the efficacy of DCP to oral corticosteroids and cyclophosphamide in combination.
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Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back.
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Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
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Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
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Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
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- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
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Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
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Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
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Restaging of Bronchogenic Carcinoma Based on 7th Edition of TNM Classification - Using Integerated PET CT.
1. Restaging of Bronchogenic Carcinoma Based on 7th Edition of
TNM Classification - Using Integerated PET CT
2. Page 1 of 44
Restaging of bronchogenic carcinoma based on 7thedition
of TNM classification - using integerated PET CT.
Poster No.: C-0943
Congress: ECR 2011
Type: Educational Exhibit
Authors: B. RAGHAVAN
1
, G. SIVARAMALINGAM
2
;
1
CHENNAI, TA/IN,
2
CHENNAI, tamilnadu/IN
Keywords: PET-CT, Oncology
DOI: 10.1594/ecr2011/C-0943
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3. Page 2 of 44
Learning objectives
1.To restage the recently diagnosed cases of bronchogenic carcinoma in our clinical
setup based on the 7th edition of TNM classification.
2.To assess the staging variation between the 6th and 7th editions using a combined
PET/CT scanner by evaluating the primary and metastatic lesions on both metabolic and
anatomic basis.
3.To assess the role of PET/CT in staging .
Background
In 2009, the seventh edition of the TNM staging system for lung cancer was published by
the International Union Against Cancer and the American Joint Committee on Cancer,
based on proposals from the International Staging Project of the International Association
for the Study of Lung Cancer (IASLC) using the 46 different data bases collected across
19 countries between 1990 and 2000, from 100,869 cases of newly diagnosed primary
lung cancer.(1)
The new 7th edition of the TNM classification system features a number of revisions,
including subdivision of tumor categories on the basis of size, differentiation between
local intra thoracic and distant metastatic disease, recategorization of malignant pleural or
pericardial disease etc, on the basis of evidence from a significantly larger worldwide data
base that has been subjected to extensive validation which attempts to better correlate
disease with prognostic value and treatment strategy.
Two primary methods of lung cancer staging are available clinical staging and pathologic
staging. Clinical staging includes minimally inasive & non invasive methods of which
imaging has a key role to play. Integrated PET CT with its depiction of anatomy & function
delineates the various TNM stages non-invasively.(2)
Images for this section:
4. Page 3 of 44
Fig. 1: 7th Edition TNM Staging
Fig. 2: Lung cancer staging in 6th and 7th edition of TNM classification. The red box
indicates unresectable disease.
6. Page 5 of 44
Imaging findings OR Procedure details
We retrospectively looked at the data of 115 patients with lung cancer, who reported to
our PET CT centre ( Apollo speciality hospitals, Chennai) from october 2009 to january
2011, out of which 60 untreated HPE proven cases were included in the study.
All paients fasted for at least six hours before the PET/CT examination, although
oral hydration with glucose- free water was allowed after ensuring a normal blood
glucose level in the peripheral blood, patients received an IV injection of 5 Mci of F-18
flurodeoxyglucose and then rested for approximately 45 minutes before scanning. Scans
were accquired using a PET/CT Scanner (Philips Gemini TF 64 Slice). Image accquisition
was done from the vertex of the skull to midthigh after IV administration of non-
ionic iodinated contrast agent (1ml/kg body weight with saline chasing) for attenuation
correction & diagnosis.
We compared and analysed the variation in individual T,N,M and the final staging, and
thereby the prognostic factors and survival differences in the patient data according to
the sixth and the seventh edition of the TNM system.
Images for this section:
7. Page 6 of 44
Fig. 1: Fig. 20: PET CT scanner.(Picture courtesy Philips Medical Systems)
8. Page 7 of 44
Fig. 2: Well defined solitary pulmonary nodule of size 1.6 cms in left lower lobe
with no mediastinal lymph nodes or distal metastases.CT guided lung Bx was done
HPE was adenocarcinoma followed by surgery. 6th edition(T1N0M0)stage IA,7th
edition(T1aN0M0)stage IA - no stage variation.
10. Page 9 of 44
Fig. 3: T1a - 1.3cms lesion more than 2cms from carina abutting right upper lobe
bronchus & no invasion proximal to lobar bronchus. The coronal image shows the
distance from the carina (3.1 cm). Final staging of 6th (III B) and 7th (III B) edition did not
alter in this case as the patient was N3 supraclavicular and lower cervical nodes.
11. Page 10 of 44
Fig. 4: T1b - Peripherally located 2.5 cms sized lesion surrounded by lung. Final Staging
(stage IV by 6th edition and 7th edition) did not change due to vertebral metastases.
12. Page 11 of 44
Fig. 5: T2a - 3.3 cms sized mass lesion (>3cms)with N2 lymphnodes (ipsilateral hilar &
subcarinal nodes ) and M1b rib metastases. Final staging (Stage IV)did not alter in 6th
& 7th edition because of rib metastases.
14. Page 13 of 44
Fig. 6: T2b - 5.8 cms (>5 cms )sized mass lesion.Fusion images show the FDG avid
peripheral component with the central area of necrosis. Final Stage III A did not alter in
both editions because of N2 lymph nodes ( not shown in image ).
15. Page 14 of 44
Fig. 7: T3 -6.6 cms sized mass with areas of necrosis in left upper lobe with mediastinal
and chest wall pleural invasion. Final Stage IIIA did not change in 6th and 7th edition
because of N2 nodes (ipsilateral hilar, lower paratracheal, and subcarinal nodes ). *The
delineation of the hyper-metabolic area facilitated proper targeting of the area to be
biopsied.
Fig. 8: T4-right upper lobe mass lesion with right main bronchus, carina and Superior
venacava (arrow) invasion. In both editions the Final stage is T4N0M0 but it is down
staged from IIIB to IIIA in 7th edition.
16. Page 15 of 44
Fig. 9: N stage Two different cases of right upper lobe mass lesion with sub carinal
lymphadenopathy (N2). Additionally the lower image shows FDG avid ipsilateral hilar
17. Page 16 of 44
node (Presence of ipsilateral hilar adenopathy alone would indicate N1 disease) in
addition to the subcarinal node however the presence of rib metastases has upstaged
the disease to Stage IV.
19. Page 18 of 44
Fig. 10: N3 left upper lobe mass lesion with CONTRALATERAL lower paratracheal &
supra clavicular lymph nodes
Fig. 11: M1a - Adeno carcinoma right upper lobe with diffuse pleural dissemination. No
significant mediastinal adenopathy. 6th edition it is T4N0M0 - STAGE IIIB, 7th edition
T3N0M1a - STAGE IV and the lesion has been upstaged.
21. Page 20 of 44
Fig. 12: M1b - Left upper lobe mass with renal & bony metastases. Stage IV in both
editions.
Fig. 13: Serial pre-operative X-rays show a right upper lobe mass which showed
progression. PET scan (PET images are in Fig 14 )was performed for staging after the
CT guided biopsy showed bronchoalveolar carcinoma.Patient underwent surgery. Post
op X-ray of the same patient(right bottom image). Post-op HPE findings confirmed the
histopathology with node -ve disease.
22. Page 21 of 44
Fig. 14: Same patient as in fig. 13 shows a 6.3 cms sized broncho alveolar type of
adenocarcinoma in right upper lobe. Non FDG avid right lower para tracheal lymph node .
6th edition(T2N0M0)STAGE IB, 7th edition(T2bN0M0)STAGE IIA- upstaged because of
size criteria.
23. Page 22 of 44
Fig. 15: Mass lesion in right lower lobe with carina, mediastinal and great
vessel (right pulmonary artery) invasion.Ipsilateral para tracheal and para aortic
lymphadenopathy,pericardial dissemination and non FDG avid right sided pleural
effusion are seen. 6th edition (T4N3M0)-STAGE IIIB, 7th edition(T4N3M1a) - STAGE IV;
lesion upstaged because of pericardial dissemination.
24. Page 23 of 44
Fig. 16: Non small cell ca in right upper lobe with mediastinal invasion & non FDG avid
spiculated nodule measuring (0.8 cms ) in superior basal segment of right lower lobe and
FDG avid necrotic right subpectoral lymph node . 6th edition (T4N3M1)-STAGE IV, 7th
edition (T4N3M0)- STAGE IIIB , the presence of satellite nodule in the same lung but
different lobe down staged the disease. PET is not sensitive in sub-centimeter nodules
and CT morphology was used in deciding the stage.
26. Page 25 of 44
Fig. 17: 7. 3 cms sized mass in right upper lobe with no mediastinal lymph nodes or
intrathoracic/distant metastasis. 6th edition (T2N0M0)-STAGE IB,7th edition (T3N0M0)
- STAGE IIB, the lesion is upstaged according to the size criteria (>7 cms - T3 in 7th
edition).
28. Page 27 of 44
Fig. 18: FDG avid 3.1 cms sized right hilar mass lesion with non FDG avid distal partial
atelectasis of anterior segment of right upper lobe. The lesion was T2 in 6th edition and
remained T2a in 7th edition due to the size criteria and metabolically inactive partial
collapse of right upper lobe.
Fig. 19: Small cell carcinoma in right hilar region with great vessels (right pulmonary
artery and vein), pericardium and bronchus intermedius invasion.Right supraclavicular
and contralateral hilar lymph nodes are also seen.(arrows) 6th edition-(T4N3M0)STAGE
IIIB,7th edition-(T4N3M1a) STAGE IV;the lesion is upstaged from IIIB to IV due to
pericardial invasion.
29. Page 28 of 44
Conclusion
Re-staging of bronchogenic carcinoma based on 7th edition and assessment of variation
between 6th and 7th edition:
• In our series the overall change in final Stage was seen in only 11 % ( Fig
1) of cases and in all the cases there was change in the management.
Population based case study by strand et al [3] revealed that based on the
current indications of therapy, nearly one-fifth (17%) of the patients could be
offered different treatment options because of the rearrangement of some
TNM subsets in different stages.
• Our case load consisted of more than 50 % of stage IV disease & we did
not have any N1 in our series & hence there was a limitation to predict the
impact of 7th edition in early T & N staging [4].
• In our series maximum change was seen in M category (Fig 2) due to the
sub-categorisation as local or distant metastatic disease to subdivision of M1
a & M1b.
• TNM staging applies to Small cell carcinoma (fig 6)& Carcinoid.[10],[11].
• The 7th edition clinical staging by imaging, helped in sub classification of the
various TNM stages and to arrive at the final Staging. And it also helped in
deciding various treatment options like surgery, chemotherapy, radiotherapy
including targeted therapies like cyber knife (fig.8), for better survival rates
(fig.4).
ROLE OF INTEGRATED PET/ CT:
• PET helped in nodal & metastatic staging work-up however it did not have
any impact in any of our cases which altered in the final staging.[7]
• PET/CT detected metastases in 39 out of the 60 cases of which maximum
were skeletal metastases(fig.5)
• PET did not have a bearing on T staging however it is able to accurately
delineate the tumor load & boundaries (fig 9) & differentiate it from
associated collapse / consolidation(fig.10) or area of necrosis,guiding
targeted biopsy from the metabolically representative area.
• PET/CT has a definite role in assessing recurrent disease based on
metabolic activity (fig.11).
• PET has limitation in brain metastases (fig.7), bronchoalveolar carcinoma
(fig.12) and in subcentimeter satellite nodules (fig.13).
• Hyper metabolism can also be seen in cases of infective lung lesions (fig.14)
and in reactive lymphadenopathy causing false positivity in PET imaging.
In these instances we use Contrast MDCT characteristics for diagnosis and
confirm by histopathological evaluation using minimally invasive techniques
like CT guided biopsy, mediastinoscopy and VATS.
30. Page 29 of 44
Images for this section:
Fig. 1: The application of 7th edition criteria altered the overall staging in 11% of cases
in our study.
31. Page 30 of 44
Fig. 2: Distribution of the change based on TNM descriptors.
Fig. 3: Distribution of cases changed in Final Staging.
35. Page 34 of 44
Fig. 6: Case of small cell carcinoma presented with hyper metabolic mass lesion in right
upper lobe with right adrenal and brain metastases (top three images).Post radiotherapy
follow up images (bottom three images) showed regression in metabolic activity as well
as size of the lesions.
36. Page 35 of 44
Fig. 7: CT and PET/CT images of the same patient showed in figure 6: Brain lesions were
not hyper metabolic in comparison to the normal brain parenchyma in PET CT,contrast
enhanced CT images helped in diagnosis of metastatic lesion.This illustrates the poor
sensitivity of PET in identifying brain metastases.
38. Page 37 of 44
Fig. 8: Mass lesion with SVC obstruction shows response to Cyber knife therapy.Top
image shows the mass with fiducials in the planning CT,post treatment response seen
in the bottom 2 images.
Fig. 9: 43 year old male with Pan coast tumor - non-small cell lung carcinoma shows
tumor regression in the post chemotherapy follow-up scan.
40. Page 39 of 44
Fig. 10: FDG avid 3.1 cms sized right hilar mass lesion with non FDG avid distal partial
atelectasis of anterior segment of right upper lobe. The lesion was T2 in 6th edition and
remained T2a in 7th edition due to the size criteria and metabolically inactive partial
collapse of right upper lobe.
Fig. 11: case of non small cell carcinoma right upper lobe, underwent right upper
lobectomy, patient received post surgery radiotherapy also.Follow up PET/CT after 2
year showed a recurrent FDG avid focus (top right image)in right upper lobe abutting the
right side of trachea. PET/CT helped in identifying and localising this local recurrence
which with CT alone will be difficult to detect in post operative scenario.
41. Page 40 of 44
Fig. 12: Well defined non FDG avid mass lesion in left upper lobe. Histo pathology is
proved to be broncho alveolar carcinoma and PET has poor sensitivity for brochoalveolar
type of adenocarcinoma.
43. Page 42 of 44
Fig. 13: Hyper metabolic spiculated mass lesion in left upper lobe with a non FDG avid
subcentimeter nodule in same lobe. Subcentimeter lesions are beyond the resolution of
PET acquisition.
Fig. 14: Hyper metabolic lesion in the left lower lobe in a 30 year old patient who
had hemoptysis. The contrast enhanced CT showed a separate arterial branches from
the descending thoracic aorta and the venous drainage is into the hemiazygos vein
suggestive of sequestration. Histopathology confirmed the same with super added
infection.
44. Page 43 of 44
Personal Information
Dr.Bagyam Raghavan, Senior consultant radiologist, Apollo speciality hospitals,Chennai,
Tamil nadu, India.
Dr.Geethapriya Sivaramalingam, Senior resident, Apollo speciality hospitals, Chennai,
Tamil nadu, India.
References
References
1. Stacy J.UyBico et.al: Lung Cancer Staging Essentials: The New TNM
Staging System and Potential Imaging pitfalls, RadioGraphics,10.1148/
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