imaging_in_lung_cancer[1] - Read-Only.pptx

imaging_in_lung_cancer[1] - Read-Only.pptx

1. Moderator: Dr Prasanthi M.D, DNB presentor : Dr . Sai kiran Imaging in bronchogenic carcinoma

2. 1) Lung cancer is the neoplasm with the highest prevalence and mortality rates in the world. 2) Most patients with lung cancer that are symptomatic have hemoptysis, coughing , shortness of breath, chest pain and persistent infections. 3) Less than 10% of patients are asymptomatic when the tumor is detected as an incidental finding

3. . Chest x-ray (CXR) is the first investigation performed during the workup of suspected lung cancer. . In the absence of a rib erosion, CXR cannot distinguish between benign and malignant masses, therefore computed tomography (CT) with contrast enhancement should be performed in order to obtain a correct staging. . Magnetic resonance imaging of the chest is considered a secondary approach as the respiratory movement affects the overall results

4. LUNG CANCER CLASSIFICATION Classifications of lung cancer by the anatomic site are : central lung cancer : - squamous cell carcinoma small cell carcinoma. peripheral lung cancer : adenocarcinoma large cell carcinoma. Classification to Histopathology : - Small Cell Lung cance r (SCLC 15-20%, small cell carcinoma) - Non-Small cell Lung Cancer (NSCLC, 80-85%, squamous cell carcinoma 30-40%, adenocarcinoma, large cell carcinoma 10%)

5. CXR FINDINGS Unilateral hilar enlargement Lung / lobe/ segmental collapse Broadening of mediastinum Enlarged cardiac shadowing Elevation of hemi diaphragm Destruction of ribs

6. SQUAMOUS CELL CARCINOMA R epresents 30% of all lung cancers . It arises from bronchial epithelium and grow s in situ. It is related to cigarette smoking. centrally located within the lung grow much larger than 4 cm in diameter. Cavitations are seen in up to 82%. They frequently cause segmental or lobar lung collapse due to their central location most common cause of the Pancost or superior sulcus syndrome.

7. GOLDEN S SIGN The Golden S-sign is seen on frontal chest radiographs. right upper lobar collapse (the right upper lobe appearing dense and shifting medially and upwards) with a central mass expanding the hilum . Together, these two changes form a reverse S-shape.

8. . ADENOCARCINOMA arises from the submucosal glands. It is considered the commonest subtype in a young woman and non-smokers In the majority of cases, it appears as a parenchymal nodule with dimensions of less than 3 centimeters May present as subsolid nodule with surrounding GGO suggesting lepidic spread of the tumour less frequently like a mass with a diameter larger than 3 centimeters.

9. So

10. Small cell carcinoma small cell tumors are located centrally in the vast majority of cases. They arise from the mainstem or the lobar bronchi and thus appear as hilar or perihilar masses  mediastinal lymph node involvement at presentation. ON CXR hilar/perihilar mass usually with mediastinal widening due to lymph node enlargement  Mediastinal involvement is often the most striking feature and the primary mass may be inapparent.

11. ON CT Small cell lung cancers are usually characterized as a mass lesion , where necrosis and hemorrhage are both common. numerous enlarged mediastinal lymph nodes. Direct infiltration of adjacent structures is common. Small cell carcinoma of the lung is the most common cause of  SVC obstruction due to both compression/thrombosis and/or direct infiltration 

12. . T1 tumors show no invasion into the lobar or more proximal bronchi. . T2 tumors include lesions that show evidence of invasion of a main bronchus regardless of the distance from the carina . . Additionally, lesions with invasion of the visceral pleura, partial or complete lung atelectasis, or pneumonitis, are classified as T2 . . T3 tumors include lesions that show direct invasion of the parietal pleura, chest wall, phrenic nerve, or parietal pericardium

13. . Lesions of any size that invade the mediastinum, diaphragm, heart, great vessels, recurrent laryngeal nerve, vertebrae, or carina are classified as T4 . . For patients with separate tumor nodules, location is important. A separate lung nodule(s) in the same lobe as the primary tumor is considered T3. . A separate lung nodule(s) in the same lung but different lobe from the primary tumor is considered T4 . A separate nodule(s) in the contralateral lung to the primary tumor is considered intrathoracic metastatic disease M1a

14. .

15. T3 disease showing chest wall invasion on CECT

16. T4 disease showing left upper lobe tumour with elevated diaphragm on same side indicating the involvement of left RLN on axial CECT

17. M1a disease showing intra thoracic metastasis on CECT showing primary tumour in right lower lobe . Seperate nodule in right middle lobe shown in short arrow . And a separate nodule in contra lateral lung shown with a long arrow

18. CECT showing well circumscribed solid mass in rght middle lobe of lung . On futher biopsy it is confirmed as a neuro endocrine carcinoid tumour .

19. CECT shows ground glass nodule with a part solid component showing focal bubbly with internal lucencies a feature if adeno carcinoma of lung

20. N3 nodal metastasis : on CECT hyperdense lesion seen in left upper lobe of lung and nodal spread into right mediastinum in paratracheal and pre vascular rgions shown in arrows

21. Pleural invasion : 8-15% of ca lung shows pleural invasion Clinical features include pleural effusion , pleural nodules , sometimes pneumothorax in rare conditions Pleural invasion most commonly occour due to direct pleural seeding or by lymphatics Pleural invasion upstages the tumour to M1a in TNM classification

22. If we see a solid mass lesion in lung with same side pleural effusion it is mostly considered as malignant condition If the pleural fluid donot contain any malignant cells we cannot rule out malignancy Pleural changes can be presented as linear pleural tags , linear pleural tag with ending nodule , pleural retraction if any of these 3 signs are seen in CT it is mostly considered as malignant

23. Pleural tag with distal pleural nodule

24. Thank you