OncologyLung cancer staging1
Introduction
Lung cancer is the leading cause of cancer death in the developed world. In the United States alone, in 2002 there were 170,000 new cases, and lung cancer accounted for 28% of all cancer deaths [1]. Accurate staging remains the cornerstone of lung cancer management and prognostication. The TNM system currently in use for the classification of non-small cell lung cancer (NSCLC) was first proposed more than 50 years ago by Denoix [2], and was later adapted by the American Joint Committee for Cancer Staging in 1974 [3]. This staging system since went through further revisions in 1986 [4] and, more recently, in 1997 [5].
The TNM system gauges the overall anatomical spread of cancer by considering the factors of tumor size and invasion, extent of lymphatic spread, and presence of metastatic disease. This anatomical basis has shaped current strategies for clinical and surgical staging investigations. Emphasis is on the detection of cytological and histological spread by means of noninvasive staging, such as imaging, or invasive staging, such as surgical biopsy. However, with advances in molecular biology rapidly expanding our understanding of cancer, this purely anatomical framework is increasingly being challenged.
This review critically appraises the roles of current staging modalities, and also presents an overview of recent developments in molecular staging.
Section snippets
Noninvasive staging
All NSCLC patients should have a thorough history taken and undergo a complete physical examination. It has been estimated that symptoms and signs may identify up to 95% of NSCLC patients with advanced, inoperable disease [6], [7], [8]. A thorough history and examination, coupled with a routine array of laboratory tests (such as alkaline phosphatase), constitute the “expanded” clinical evaluation [9]. Abnormal findings from such an evaluation are associated with an approximate 50% incidence of
Invasive staging
It is acknowledged that each noninvasive staging modality has specific drawbacks. Ultimately, not even the latest imaging techniques, such as PET, can provide infallible staging; hence cytological or histological confirmation of suspected metastases (invasive staging) is frequently required [26].
Molecular staging
The advent of molecular biology represents the most significant development in lung cancer staging in the past few decades and promises to revolutionize the way clinicians conceptualize the spread of this disease through the human body. The current anatomically based TNM system for lung cancer staging has well-recognized limitations. Within the conventional staging system, there remain patients whose progress and prognosis defy their accorded stage. For example, patients with stage IA NSCLC
Conclusion
Accurate staging remains essential for lung cancer management. Recent developments in both noninvasive and invasive staging investigations are changing the algorithms for lung cancer staging. For example, a negative PET scan for the mediastinum now renders mediastinoscopy unnecessary in most instances, while VATS offers a minimally invasive yet highly accurate means of preresection histological staging. These imaging and surgical techniques will continue to evolve, and surgeons should keep
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Optimal route planning for image-guided EBUS bronchoscopy
2019, Computers in Biology and MedicineComprehensive clinical staging for resectable lung cancer: Clinicopathological correlations and the role of brain MRI
2016, Journal of Thoracic OncologyCitation Excerpt :This suggests that even in patients in whom brain metastases will eventually develop, the preoperative brain MRI scan does not provide any additional information that could translate into more timely treatment and improved patient outcomes. The results of this study, in addition to previous studies,3,5,6,18,27,28 are in support of omitting MRI of the brain from the routine staging of asymptomatic patients with early-stage lung cancer who are being considered for surgery. Almost a third of the costs of staging (31.9%) in this population were dedicated to brain MRI.
Data mining in lung cancer pathologic staging diagnosis: Correlation between clinical and pathology information
2015, Expert Systems with ApplicationsCitation Excerpt :The lung cancer pathologic staging is assigned based on the results of pathology report. It describes the size and/or the extent of the original tumour and whether the cancer has spread (metastasis) (Sihoe & Yim, 2004; Vu-Quang et al., 2011). Being aware of the lung cancer pathologic staging is important because it can be used to estimate a patient’s prognosis and also can help physicians plan a suitable treatment (Edge & Compton, 2010).
Thoracic cavity definition for 3D PET/CT analysis and visualization
2015, Computers in Biology and MedicineCitation Excerpt :During the lung-cancer detection and staging process, a patient generally receives a co-registered whole-body PET/CT scan pair, collected as the patient breathes freely, and a dedicated high-resolution chest CT scan, collected during a breath hold. With this scan combination, multimodal PET/CT ROI information can be gleaned from the co-registered PET/CT scan pair, while the dedicated chest CT scan enables precise planning of follow-on chest procedures such as bronchoscopy and radiation therapy [3–5]. For all of these tasks, effective image segmentation of the thoracic cavity is important to help focus attention on the central-chest region.
Adaptation of diagnostic tests and non-invasive management in the elderly with lung cancer: ultrasound guided fine needle puncture of enlarged supraclavicular lymph node
2018, Revista Espanola de Geriatria y Gerontologia
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Presented at Advances in Surgery, a scientific symposium in honor of David B. Skinner, M.D., Chicago, IL, October 19, 2003.