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Chapter 085. Neoplasms of the Lung (Part 9)

Chest radiographs and CT scans are needed to evaluate tumor size and nodal involvement; old radiographs are useful for comparison. CT scans of the thorax and upper abdomen are of use in the preoperative staging of NSCLC to detect mediastinal nodes and pleural extension and occult abdominal disease (e.g., liver, adrenal), and in planning curative radiation therapy. However, mediastinal nodal involvement should be documented histologically if the findings will influence therapeutic decisions. Thus, sampling of lymph nodes via mediastinoscopy or thoracotomy to establish the presence or absence of N2 or N3 nodal involvement is crucial in considering a curative surgical. | Chapter 085. Neoplasms of the Lung Part 9 Chest radiographs and CT scans are needed to evaluate tumor size and nodal involvement old radiographs are useful for comparison. CT scans of the thorax and upper abdomen are of use in the preoperative staging of NSCLC to detect mediastinal nodes and pleural extension and occult abdominal disease e.g. liver adrenal and in planning curative radiation therapy. However mediastinal nodal involvement should be documented histologically if the findings will influence therapeutic decisions. Thus sampling of lymph nodes via mediastinoscopy or thoracotomy to establish the presence or absence of N2 or N3 nodal involvement is crucial in considering a curative surgical approach for patients with NSCLC with clinical stage I II or III disease regardless of whether the PET is positive or negative. A preoperative mediastinoscopy may not need to be done in patients with normal-size nodes by CT that are PET-negative as the discovery of micrometastases is unlikely to change the preoperative management of the disease although lymph node sampling should be done intraoperatively. A standard nomenclature for referring to the location of lymph nodes involved with cancer has evolved Fig. 85-1 . Unless the CT-detected abnormalities are unequivocal histology of suspicious extrathoracic lesions should be confirmed by procedures such as fine-needle aspiration if the patient would otherwise be considered for curative treatment. In SCLC CT scans are used in the planning of chest radiation treatment and in the assessment of the response to chemotherapy and radiation therapy. Surgery or radiotherapy can make interpretation of conventional chest x-rays difficult after treatment CT scans can provide good evidence of tumor recurrence. Figure 85-1 Regional lymph node stations for lung cancer staging. Used by permission from CF Mountain C Dresler Chest 111 1718 1997.