European Journal of Radiology
Volume 45, Issue 1 , Pages 18-30 , January 2003

Staging of non-small cell lung cancer: imaging of intrathoracic disease

  • Sharyn L.S MacDonald

      Affiliations

    • Department of Radiology, Christchurch Hospital, Christchurch 8001, New Zealand
  • ,
  • David M Hansell

      Affiliations

    • Department of Radiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
    • Corresponding Author InformationCorresponding author. Tel.: +44-207-351-8034; fax: +44-207-351-8098

Received 17 September 2002 ,Revised 18 September 2002 ,Accepted 19 September 2002.

References 

  1. Mountain CF. Revisions in the international system for staging lung cancer. Chest. 1997;111:1710–1717
  2. Belli L, Meroni A, Rondianara G, et al.  Bronchoplastic procedures and pulmonary artery reconstruction in the treatment of bronchogenic cancer. J. Thorac. Cardiovasc. Surg. 1985;90:167–171
  3. Mountain CF. Surgery for stage IIIa-N2 non-small cell lung cancer. Cancer. 1994;73:2589–2598
  4. Martini N, Kris MG, Flehinger BJ, et al.  Preoperative chemotherapy for stage IIIa(N2) lung cancer: the Sloan–Kettering experience with 136 patients. Ann. Thorac. Surg. 1993;55:1365–1374
  5. Rusch VW, Albain KS, Crowley JJ, et al.  Surgical resection of stage IIIA and stage IIIB non-small-cell lung cancer after concurrent induction chemoradiotherapy. J. Thorac. Cardiovasc. Surg. 1993;105:97–106
  6. Naruke T, Goya T, Tsuchiya R, et al.  Prognosis and survival in resected lung carcinoma based on the new international staging system. J. Thorac. Cardiovasc. Surg. 1988;96:440–447
  7. Epstein DM, Stephenson LW, Gefter WB, et al.  Value of CT in the preoperative assessment of lung cancer: a survey of thoracic surgeons. Radiology. 1986;161:423–427
  8. Lahde S, Paivansalo M, Rainio P. CT for predicting the resectability of lung cancer: a prospective study. Acta Radiol. 1991;32:449–454
  9. Lewis JW, Pearlberg JL, Beute GH, et al.  Can computed tomography of the chest stage lung cancer? Yes and no. Ann. Thorac. Surg. 1990;49:591–596
  10. Quint LE, Glazer GM, Orringer MB. Central lung masses: prediction with CT of need for pneumonectomy versus lobectomy. Radiology. 1987;165:735–738
  11. Gay SB, Black WB, Armstrong P, et al.  Chest CT of unresectable lung cancer. RadioGraphics. 1988;8:735–748
  12. Primack SL, Lee KS, Logan PM, Miller RR, Muller NL. Bronchogenic carcinoma: utility of CT in the evaluation of patients with suspected lesions. Radiology. 1994;193:795–800
  13. Martini N, Heelan R, Westcott J, et al.  Comparative merits of conventional computed tomograpic and magnetic resonance imaging in assessing mediastinal involvement in surgically confirmed lung carcinoma. J. Thorac. Cardiovasc. Surg. 1985;90:639–648
  14. White PG, Adams H, Crane MD, et al.  Preoperative staging of carcinoma of the bronchus: can computed tomographic scanning reliably identify stage III tumours?. Thorax. 1994;49:951–957
  15. Glazer HS, Kaiser LR, Anderson DJ, et al.  Indeterminate mediastinal invasion in bronchogenic carcinoma: CT evaluation. Radiology. 1989;173:37–42
  16. Scott IR, Muller NL, Miller RR, et al.  Resectable stage III lung cancer: CT, surgical and pathologic correlation. Radiology. 1988;166:75–79
  17. Musset D, Grenier P, Carette MF, et al.  Primary lung cancer staging: prospective comparative study of MR imaging with CT. Radiology. 1986;160:607–611
  18. Stiglbauer R, Schurawitzki H, Klepetko W. Contrast-enhanced MRI for the staging of bronchogenic carcinoma: comparison with CT and histopathologic staging—preliminary results. Clin. Radiol. 1991;44:293–298
  19. Mayr B, Lenhard M, Fink U, et al.  Preoperative evaluation of bronchogenic carcinoma: value of MR in T- and N-staging. Eur. J. Radiol. 1992;14:245–251
  20. Webb WR, Gatsonis C, Zerhouni EA, et al.  CT and MR imaging in staging non-small cell bronchogenic carcinoma: report of the Radiologic Diagnostic Oncology Group. Radiology. 1991;178:705–713
  21. Gefter WB. Magnetic resonance imaging in the evaluation of lung cancer. Semin. Roentgenol. 1990;25:73–84
  22. Haramati LB, White CS. MR imaging of lung cancer. MRI Clin. N. Am. 2000;8:43–57
  23. Piehler JM, Pairolero PC, Weiland LH, et al.  Bronchogenic carcinoma with chest wall invasion: factors affecting survival following en-bloc resection. Ann. Thorac. Surg. 1982;34:684–691
  24. McCaughan BC, Martini N, Bains MS, et al.  Chest wall invasion of carcinoma of the lung: therapeutic and prognostic implications. J. Thorac. Cardiovasc. Surg. 1985;89:836–841
  25. Ratto GB, Piacenza G, Frola C, et al.  Chest wall involvement by lung cancer: computed tomographic detection and results of operation. Ann. Thorac. Surg. 1991;51:182–188
  26. Allen MS, Mathisen DJ, Grillo HC, et al.  Bronchogenic carcinoma with chest wall invasion. Ann. Thorac. Surg. 1991;51:948–951
  27. McLoud TC, Swensen SJ. Lung carcinoma. Clin. Chest Med. 1999;20:697–713
  28. Quint LE, Francis IR, Wahl RL, Gross BH, Glazer GM. Preoperative staging of non-small-cell carcinoma of the lung: imaging methods. Am. J. Roentgenol. 1995;164:1349–1359
  29. Pennes DR, Glazer GM, Wimbish KJ, et al.  Chest wall invasion by lung cancer: limitations of CT evaluation. Am. J. Roentgenol. 1985;144:507–511
  30. Glazer HS, Duncan-Meyer J, Aronberg DJ, et al.  Pleural and chest wall invasion in bronchogenic carcinoma: CT evaluation. Radiology. 1985;157:191–194
  31. Pearlberg JL, Sandler MA, Beute GH. Limitations of CT in evaluation of neoplasms involving chest wall. J. Comput. Assist. Tomogr. 1987;11:290–293
  32. Webb WR, Jeffrey RB, Godwin JD. Thoracic computed tomography in superior sulcus tumors. J. Comput. Assist. Tomogr. 1981;5:361–365
  33. O'Connell RS, McLoud TC, Wilkins EW. Superior sulcus tumor: radiographic diagnosis and workup. Am. J. Roentgenol. 1983;140:25–30
  34. Heelan RT, Demas BE, Caravelli JF, et al.  Superior sulcus tumors: CT and MR imaging. Radiology. 1989;170:637–641
  35. McLoud TC, Filion RB, Edelman RR, Shepard JO. MR imaging of superior sulcus carcinoma. J. Comput. Assist. Tomogr. 1989;13:233–239
  36. Freundlich IM, Chasen MH, Varma DGK. Magnetic resonance imaging of pulmonary apical tumors. J. Thorac. Imaging. 1996;11:210–222
  37. Takasugi JE, Rapoport S, Shaw C. Superior sulcus tumors: the role of imaging. J. Thorac. Imaging. 1989;4:41–48
  38. Hanson JA, Armstrong P. Staging intrathoracic non-small-cell lung cancer. Eur. Radiol. 1997;7:161–172
  39. Remy-Jardin M, Duyck P, Remy J, et al.  Hilar lymph nodes: identification with spiral CT and histologic correlation. Radiology. 1995;196:387–394
  40. Genereux GP, Howie JL. Normal mediastinal lymph node size and number: CT and anatomic study. Am. J. Roentgenol. 1984;142:1095–1100
  41. Quint LE, Glazer GM, Orringer MB. Mediastinal lymph node detection and sizing at CT and autopsy. Am. J. Roentgenol. 1986;147:469–472
  42. Libshitz HI, McKenna RJ. Mediastinal lymph node size in lung cancer. Am. J. Roentgenol. 1984;143:713–718
  43. Kerr KM, Lamb D, Wathen CG, Walker WS, Douglas NJ. Pathological assessment of mediastinal lymph nodes in lung cancer: implications for non-invasive mediastinal staging. Thorax. 1992;47:337–341
  44. McLoud TC, Bourgouin PM, Greenberg RW, et al.  Bronchogenic carcinoma: analysis of staging in the mediastinum with CT by correlative lymph node mapping and sampling. Radiology. 1992;182:319–323
  45. Arita T, Kuramitsu T, Kawamura M, et al.  Bronchogenic carcinoma: incidence of metastases to normal sized lymph nodes. Thorax. 1995;50:1267–1269
  46. Gross BH, Glazer GM, Orringer MB, Spizarny DL, Flint A. Bronchogenic carcinoma metastatic to normal-sized lymph nodes: frequency and significance. Radiology. 1988;166:71–74
  47. Grenier P, Dubray B, Carette MF, et al.  Pre-operative thoracic staging of lung cancer: CT and MR evaluation. Diagn. Interv. Radiol. 1989;1:23
  48. Glazer GM, Orringer MB, Chenevert TL, et al.  Mediastinal lymph nodes: relaxation time/pathologic correlation and implications in staging of lung cancer with MR imaging. Radiology. 1988;168:429–431
  49. Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest. 1997;111:1718–1723
  50. Tisi GM, Friedman PJ, Peters RM, et al.  Clinical staging of primary lung cancer: official statement of the American Thoracic Society. Am. Rev. Respir. Dis. 1983;127:659
  51. Pearson FG, DeLarue NG, Ilves R, Todd TRJ, Cooper JD. Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung. J. Thorac. Cardiovasc. Surg. 1982;83:1–11
  52. Goldstraw P, Mannam GC, Kaplan DK, Michail P. Surgical management of non-small-cell lung cancer with ipsilateral mediastinal node metastasis (N2 disease). J. Thorac. Cardiovasc. Surg. 1994;107:19–27
  53. Vansteenkiste JF, De Leyn PR, Deneffe GJ, et al.  Survival and prognostic factors in resected N2 non-small cell lung cancer: a study of 140 cases. Leuven Lung Cancer Group. Ann. Thorac. Surg. 1997;63:1441–1450
  54. Conces DJ, Klink JF, Tarver RD, Moak GD. T1N0M0 lung cancer: evaluation with CT. Radiology. 1989;170:643–646
  55. Heavey LR, Glazer GM, Gross BH, Francis IR, Orringer MB. The role of CT in staging radiographic T1N0M0 lung cancer. Am. J. Roentgenol. 1986;146:285–290
  56. Pearlberg JL, Sandler MA, Beute GH, Madrazo BL. T1N0M0 bronchogenic carcinoma: assessment by CT. Radiology. 1985;157:187–190
  57. Daly BD, Faling LJ, Bite G, et al.  Mediastinal lymph node evaluation by computed tomography in lung cancer. An analysis of 345 patients grouped by TNM staging, tumor size, and tumor location. J. Thorac. Cardiovasc. Surg. 1987;94:664–672
  58. Becker GL, Whitlock WL, Schaefer PS, Tenholder MF. The impact of thoracic computed tomography in clinically staged T1, N0, M0 chest lesions. Arch. Intern. Med. 1990;150:557–559
  59. Seely JM, Mayo JR, Miller RR, Muller NL. T1 lung cancer: prevalence of mediastinal nodal metastases and diagnostic accuracy of CT. Radiology. 1993;186:129–132
  60. Parker LA, Mauro A, Delany DJ, King CW. Evaluation of T1 N0 M0 lung cancer with CT. J. Comput. Assist. Tomogr. 1991;15:943–947
  61. Duncan KA, Gomersall LN, Weir J. Computed tomography of the chest in T1N0M0 non-small cell bronchial carcinoma. Br. J. Radiol. 1993;66:20–22
  62. Sahn SA. Pleural effusion in lung cancer. Clin. Chest Med. 1993;14:189–200
  63. Decker DA, Dines DE, Payne WS, et al.  The significance of a cytologically negative pleural effusion in bronchogenic carcinoma. Chest. 1978;74:640–642
  64. Patz EF, Erasmus JJ, McAdams HP, et al.  Lung cancer staging and management: comparison of contrast-enhanced and nonenhanced CT of the thorax. Radiology. 1999;56–60
  65. Quint LE, Francis IR. Radiologic staging of lung cancer. J. Thorac. Imaging. 1999;14:235–246
  66. Silvestri GA, Littenberg B, Colice GL. The clinical evaluation for detecting metastatic lung cancer. A meta-analysis. Am. J. Respir. Crit. Care Med. 1995;152:225–230
  67. Onitsuka H, Tsukada M, Araki A, et al.  Differentiation of central lung tumour from post-obstructive lobar collapse by rapid sequence computed tomography. J. Thorac. Imaging. 1991;6:28–31
  68. Muller NL, Fraser RS, Colman NC, Pare PD. In: Radiologic diagnosis of diseases of the chest. 1st ed. Philadelphia: W.B. Saunders Company; 2001;p. 229–232
  69. Haramati LB, Cartagena AM, Austin JHM. CT evaluation of mediastinal lymphandenopathy: non-contrast 5 mm vs. post-contrast 10 mm sections. J. Comput. Assist. Tomogr. 1995;19:375–378
  70. Shimoyama K, Murata K, Takahashi M, et al.  Pulmonary hilar lymph node metastases from lung cancer: evaluation based on morphology at thin section, incremental, dynamic CT. Radiology. 1997;203:187–195
  71. Storto ML, Ciccotosto C, Guidotti A, et al.  Neoplastic extension across pulmonary fissures: value of spiral computed tomography and multiplanar reformations. J. Thorac. Imaging. 1998;13:204–205
  72. Watanabe A, Shimokata K, Saka H, et al.  Chest CT combined with artificial pneumothorax: value in determining origin and extent of tumor. Am. J. Roentgenol. 1991;156:707–710
  73. Murata K, Takahashi M, Mori M, et al.  Chest wall and mediastinal invasion by lung cancer: evaluation with multisection expiratory dynamic CT. Radiology. 1994;191:251–255
  74. Ohtsuka T, Minami M, Nakajima J, et al.  Cine computed tomography for evaluation of tumours invasive to the thoracic aorta: seven clinical experiences. J. Thorac. Cardiovasc. Surg. 1996;112:190–192
  75. Yokoi T, Mori K, Miyazawa N, et al.  Tumor invasion of the chest wall and mediastinum in lung cancer: evaluation with pneumothorax CT. Radiology. 1991;181:147–152
  76. Nolop KB, Rhodes CG, Brudin LH, et al.  Glucose utilization in vivo by human pulmonary neoplasms. Cancer. 1987;60:2682–2689
  77. Duhaylongsod FG, Lowe VJ, Patz E, et al.  Lung tumor growth correlates with glucose metabolism measured by fluoride-18 fluorodeoxyglucose positron emission tomography. Ann. Thorac. Surg. 1995;60:1348–1352
  78. Pieterman RM, van Putten JWG, Meuzelaar JJ, et al.  Preoperative staging of non-small-cell lung cancer with 18-fluorodeoxyglucose positron-emission tomography. N. Engl. J. Med. 2000;343:254–261
  79. Lewis PJ, Salama A. Uptake of fluorine-18-fluorodeoxyglucose in sarcoidosis. J. Nucl. Med. 1994;35:1647–1649
  80. Lewis P, Griffin S, Marsden P, et al.  Whole-body 18F-fluorodeoxyglucose positron emission tomography in preoperative evaluation of lung cancer. Lancet. 1994;344:1265–1266
  81. Guhlmann A, Storck M, Kotzerke J, et al.  Lymph node staging in non-small cell lung cancer: evaluation by [18]FDG positron emission tomography (PET). Thorax. 1997;52:438–441
  82. Vansteenkiste JF, Stroobants SG, De Leyn PR, et al.  Mediastinal lymph node staging with FDG-PET scan in patients with potentially operable non-small cell lung cancer: a prospective analysis of 50 cases. Leuven Lung Cancer Group. Chest. 1997;112:1480–1486
  83. Vansteenkiste JF, Stroobants SG, De Leyn PR, et al.  Lymph node staging in non-small-cell lung cancer with FDG-PET scan: a prospective study on 690 lymph node stations from 68 patients. J. Clin. Oncol. 1998;16:2142–2149
  84. Steinert H, Hauser M, Allemann F, et al.  Non-small cell lung cancer: nodal sampling with FDG PET versus CT with correlative lymph node mapping and sampling. Radiology. 1997;202:441–446
  85. Wahl RL, Quint LE, Greenough RL, et al.  Staging of mediastinal non-small cell lung cancer with FDG-PET, CT and fusion images: preliminary prospective evaluation. Radiology. 1994;191:371–377
  86. Dwamena BA, Sonnad SS, Angobaldo JO, et al.  Metastases from non-small cell lung cancer: mediastinal staging in the 1990s—meta-analytic comparison of PET and CT. Radiology. 1999;213:530–536
  87. Gambhir SS, Hoh CK, Phelps ME, Madar I, Maddahi J. Decision tree sensitivity analysis for cost-effectiveness of FDG-PET in the staging and management of non-small-cell lung carcinoma. J. Nucl. Med. 1996;37:1428–1436
  88. Dietlein M, Weber K, Gandjour A, et al.  Cost-effectiveness of FDG-PET for the management of potentially operable non-small-cell lung cancer: priority for a PET-based strategy after nodal-negative results. Eur. J. Nucl. Med. 2000;27:1598–1609
  89. Laking G, Price P. 18-Fluorodeoxyglucose positron emission tomography (FDG-PET) and the staging of early lung cancer. Thorax. 2001;56:ii38–ii44
  90. Sazon DA, Santiago SM, Soo Hoo GW, et al.  Fluorodeoxyglucose-positron emission tomography in the detection and staging of lung cancer. Am. J. Respir. Crit. Care Med. 1996;153:417–421
  91. Chin R, Ward R, Keyes JW, et al.  Mediastinal staging of non-small-cell lung cancer with positron emission tomography. Am. J. Respir. Crit. Care Med. 1995;152:2090–2096
  92. Patz EF, Lowe VJ, Goodman PC, et al.  Thoracic nodal staging with PET imaging with 18 FDG in patients with bronchogenic carcinoma. Chest. 1995;108:1617–1621
  93. Scott WJ, Gobar LS, Terry JD, et al.  Mediastinal lymph node staging of non-small-cell lung cancer: a prospective comparison of computed tomography and positron emission tomography. J. Thorac. Cardiovasc. Surg. 1996;111:642–648
  94. Gress FG, Savides TJ, Sandler A, et al.  Endoscopic ultrasonography, fine needle aspiration biopsy guided by endoscopic ultrasonography, and computed tomography in the preoperative staging of non-small-cell lung cancer: a comparison study. Ann. Intern. Med. 1997;127:604–612
  95. Silvestri GA, Hoffman BJ, Bhutani MS, et al.  Endoscopic ultrasound with fine-needle aspiration in the diagnosis and staging of lung cancer. Ann. Thorac. Surg. 1996;61:1441–1446
  96. Hawes RH, Gress F, Kesler K, et al.  Endoscopic ultrasound versus computed tomography in the evaluation of the mediastinum in patients with non-small-cell lung cancer. Endoscopy. 1994;26:784–787
  97. Williams DB, Sahai AV, Aabakken L, et al.  Endoscopic ultrasound guided fine needle aspiration biopsy: a large single center experience. Gut. 1999;44:720–726
  98. Hunerbein M, Ghadimi BM, Haensch W, et al.  Transoesphageal biopsy of mediastinal and pulmonary tumors by means of endoscopic guidance. J. Thorac. Cardiovasc. Surg. 1998;116:554–559
  99. Penman I, Fergusson RJ. Endoscopic ultrasound: a useful tool to assess the mediastinum in patients with lung cancer?. Thorax. 2002;57:95–96
  100. Wiersema MJ, Edell ES, Midthun DE, et al.  A blinded prospective study comparing transbronchial needle aspiration (TBNA) and endosonography guided needle aspiration (EUS FNA) in the staging of mediastinal lymphadenopathy in patients with non small cell lung cancer. Gastrointest. Endosc. 2001;53:AB556

PII: S0720-048X(02)00300-5

European Journal of Radiology
Volume 45, Issue 1 , Pages 18-30 , January 2003