Lymph nodal stations in ca lung

Lymph nodal stations in ca lung

1. RADIOLOGICAL ANATOMY OF THORAX

2. Surface Marking

3. BORDERS OF THE LUNG The apex is about 2cm above the medial 1/3 of the clavicle The anterior border of both lungs run downwards & medially meeting each other in the midline behind the angle of Louis. The anterior border of right lung continues running downwards till the 6 th costochondral junction. The anterior border of left lung continues running downwards till the 4 th costal cartilage then curves laterally ½ inch forming the cardiac notch then descends downwards till the 6 th costochondral junction. The lower border of the lungs represented by a line starting from 6 th rib in the MCL, 8 th rib in the MAL & 10 th rib in the mid scapular line.

4. Lung Fissures: Oblique fissure (Right & Left): It starts at the 3 rd thoracic spine while the arms are elevated, descends downwards, laterally & anteriorly along the medial border of the scapula touching the inferior angle of the scapula) cutting the mid axillary line in the 5 th rib & ending at the 6 th costal cartilage 3 inches from the midline. The transverse fissure (Right): It arises at the 4 th costal cartilage, runs horizontally to meet the oblique fissure in the mid axillary line in the 5 th rib.

5. Fissures & Lobes of the Lungs

6. X Ray Chest

7. Findings on Chest X-ray Nodule (< 3cm) vs. Mass (>= 3cm) Location: Peripheral ( Adenocarcinoma ) vs Central ( Squamous ) Single or multiple (metastases) Atelectasis of lobe or lung Pneumonia Hilar and mediastinal adenopathy Pleural effusions

8. CT Anatomy of Thorax

9. CT Scan of Thorax Nodule details: Calcification, spiculation Evaluate extension into adjacent structures: Endobronchial , great vessels, pericardium etc Evaluation of adenopathy Upper abdominal pathology: Metastatic lesions in liver, adrenals, & kidneys.

10. Common radiological appearances of lung cancer. Centrally located mass with mediastinal invasion (arrow, a) Peripherally situated mass abutting the pleura (arrow, B) Mass with smooth, lobulated margins (arrow, C) With spiculated , irregular margins (arrow, D)

11. Squamous cell cancer presenting as a cavitating mass ( arrow,a ) Adenocarcinoma presenting as dense consolidation (arrow, B). Bronchoalveolar carcinoma presenting as ground-glass opacity (arrow, c) Mixed density, solid (arrow), and ground-glass nodules (arrowhead) in d

12. Stage T1 tumor due to size <3 cm (arrow, A). Stage T2 endobronchial tumor (arrowhead) causing pneumonitis restricted to the upper lobe (arrow) in B. T2a tumor >3 cm but <5 cm (arrow, C). T2b tumor >5 cm but <7 cm (arrow in D)

13. Stage T4 tumors . T4 tumor due to invasion of pulmonary artery (arrow, a), Descending aorta (arrow, b), Vertebral body (arrow, c), Superior vena cava with thrombus (arrow, d)

14. CT Anatomy of Lymph Node Stations

15. The International Association for the Study of Lung Cancer Lymph Node Map: A Radiologic Atlas and Review 14 LN stations reorganized into 7 zones Supraclavicular zone Upper zone AP zone Subcarinal zone Lower zone Hilar zone Peripheral zone

16. Station 1 Low cervical, supraclavicular and sternal notch nodes Upper border : Lower margin of cricoid cartilage Lower border : Clavicle bilaterally and in midline upper border of manubrium

17. Upper zone

18. AP zone

19. Subcarinal zone

20. Lower zone

21. Hilar zone

22. Peripheral Zone Station 12 : Node adjacent to lobar bronchi Station 13 : Node adjacent to segmental bronchi Station 14 : Node adjacent to subsegmental bronchi

23. Contouring Guidelines

24. THANK YOU