McLoud, Theresa C

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Your story matters.Citation McLoud, Theresa C. 2014. “Staging of lung cancer CT andPET.” Cancer Imaging 14 (Suppl 1): O6. doi:10.1186/1470-7330-14-S1-O6. http://dx.doi.org/10.1186/1470-7330-14-S1-O6.Published Version doi:10.1186/1470-7330-14-S1-O6Accessed February 17, 2015 6:38:47 AM ESTCitable Link http://nrs.harvard.edu/urn-3:HUL.InstRepos:13454806Terms of Use This article was downloaded from Harvard University's DASHrepository, and is made available under the terms and conditionsapplicable to Other Posted Material, as set forth athttp://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAAORAL PRESENTATION Open AccessStaging of lung cancer CT and PETTheresa C McLoudFrom International Cancer Imaging Society (ICIS) 14th Annual Teaching CourseHeidelberg, Germany. 9-11 October 2014Lung cancer is the leading cause of cancer related deathsin the United States with a 5 year survival of only 15%.[1] The International Association for the Study of LungCancer (IASLC) issued a 7th edition of the TNM stagingsystem for lung cancer in 2007. [2] It includes severalrevisions which better align TNM staging with prognosisand in some cases with treatment.There have been revisions in the TNM descriptors. Inthe T or tumor category, the T1 and T2 categoriesinclude now subcategorization of size with new T1a, T1b,T2a and T2b subdescriptors. One of the importantchanges is that tumors larger than 7 cm are now consid-ered Stage T3 tumors. Stage IV tumors include separatetumor nodules in the same lung but not in the same lobeas the primary lesion which we r ep r e v i o u s l yc o n s i d e r e dmetastatic (M1). Stage T4 disease is now downgraded toStage III when satellite nodules are present in the samelobe as the primary lesion. The presence of malignantpleural effusion, pleural dissemination or pericardial dis-ease is now considered metastatic disease, specificallystage M1a for local intrathoracic disease rather thanStage IV disease [3-5].Although the IASLC has proposed a new lymph nodemap there are no changes to the end descriptors in the7th edition of the TNM staging system [3-5].Nearly one half of newly diagnosed lung cancersalready demonstrate metastases within the lung, brain,liver, and bony structures. Any metastatic disease isautomatically designated Stage IV disease and with fewexceptions is considered surgically unresectable. The Mcategory is now subcategorized into intra-thoracicmetastasis M1a and extra-thoracic metastatic M1b withthe former having a better prognosis [4].Contrast enhanced CT remains the mainstay for stagingof lung cancer. However, PET has particular value innodal staging of lung cancer and also in determining thepresence of distant metastatic disease. In a study byGould et al, the sensitivity of PET CT for metastasis was85% and the specificity was 95% as compared with a CTsensitivity of 61% and specificity of 79% [6]. PET CT doeshave a high false positive rate so it cannot replace invasivesampling, but it may be used to direct invasive staging.PET scanning is particularly useful in M staging of non-small cell lung cancer. PET can replace the use of bonescintigraphy and it is now widely used for determinationof distant metastasis throughout the body. However, it islimited in the assessment of brain metastases. In the PLUSTrial, 188 patients with potentially resectable non-smallcell lung cancer were randomized to either conventionalwork up or PET CT. Addition of the PET CT to theconventional work up prevented future surgery in 1 out of5 patients [7].Published: 9 October 2014References1. American Cancer Society: Cancer facts and figures 2008. Atlanta, GA:American Cancer Society; 2008.2. Goldstraw P, Crowley J, Chansky K, et al: The IASLC Lung Cancer StagingProject: Proposals for the revision of the TNM stage groupings in theforthcoming (seventh) edition of the TNM classification of malignanttumours. J Thorac Oncol 2007, 2(8):706-714.3. Rami-Porta R, Ball D, Crowley J, et al: The IASLC Lung Cancer StagingProject: Proposals for the revision of the T descriptors in theforthcoming (seventh) edition of TNM classification for lung cancer.J Thorac Oncol 2007, 2(7):593-602.4. Postmus PE, Brambilla E, Chansky K, et al: The IASLC Lung Cancer StagingProject: Proposals for revision of the M descriptors in the forthcoming(seventh) edition of the TNM classification of lung cancer. J Thorac Oncol2007, 2(8):686-693.5. Rusch VW, Asamura H, Wantanabe H, et al: The IASLC lung cancer stagingproject: A proposal for a new international lymph node map in theforthcoming seventh edition of the TNM classification for lung cancer.J Thorac Oncol 2009, 4(5):568-577.6. Gould MK, Kuschner WG, Rydzak BA, et al: Test performance of positronemission tomography and computed tomography for mediastinalstaging in patients with non-small-cell lung cancer: A meta-analysis.Ann Intern Med 2003, 139(11):879-892.7. Van Tinteren H, Hoekstra OS, Smit EF, et al: Effectiveness of positronemission tomography in the preoperative assessment of patients withsuspected non-small-cell lung cancer: The PLUS multicentre randomisedtrial. The Lancet 2002, 359(9325):1388-1392. Department of Radiology, Massachusetts General Hospital/Harvard MedicalSchool, Boston, MA 02114, USAMcLoud Cancer Imaging 2014, 14(Suppl 1):O6http://www.cancerimagingjournal.com/content/14/S1/O6© 2014 McLoud; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproductionin any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.doi:10.1186/1470-7330-14-S1-O6Cite this article as: McLoud: Staging of lung cancer CT and PET. CancerImaging 2014 14(Suppl 1):O6.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color ﬁgure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitMcLoud Cancer Imaging 2014, 14(Suppl 1):O6http://www.cancerimagingjournal.com/content/14/S1/O6Page 2 of 2

Staging of lung cancer CT and PET

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Staging of lung cancer CT and PET

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