肺癌肿瘤分期与CT影像学表现课件

肺癌的肿瘤分期及CT影像学表现

肺癌的肿瘤分期及CT影像学表现1T1T1:Atumorlessthanorequalto3cmingreatestdimension,surroundedbylungorvisceralpleura,withoutbronchoscopicevidenceofinvasionmoreproximalthanthelobarbronchus(i.e.,notinthemainbronchus).

T1T1:Atumorlessthanorequ2T1Example1:ThisisanexampleofarightlungT1lesion(inthiscaseanadenocarcinoma).Thetumormeasures2.4cminsizeandiscompletelysurroundedbylung.

T1Example1:Thisisanexampl3T1Example2:ThisisanexampleofaT1lesionintheleftlung(thenodulardensityintherightlunganteriorly[bluearrow]istheinferiormarginoftherightclavicularhead).Thetumormeasures1.8cminsizeandiscompletelysurroundedbylung.Athinlineardensityradiatestothepleuralsurfacefromthelesion-thisisreferredtoasa"pleuraltag"whichisfelttorepresenttumor-inducedthickeningoftheinterlobularsepta.Thereisafocaltriangular-shapedpleural-baseddensityidentifiedattheinsertionofthe"pleuraltag"(blackarrow).Thisfindingisfelttobesecondarytothedesmoplasticreactionincitedbythetumor.Thereisretractionofthevisceralpleuratowardsthelesion,andasmallquantityoffluidcollectswithinthespaceformedbetweenthevisceralandparietalpleuraproducingthefindingidentifiedoncomputedtomography.Thefindingdoesnotindicatevisceralpleuralinvasion.

T1Example2:Thisisanexampl4T2T2:Atumorwithanyofthefollowingfeatures:

i)Largerthan3cminlargestdimension

ii)Associatedwithatelectasisorpost-obstructivepneumonitisthatextendstothehilarregion,butdoesnotinvolvetheentirelung

iii)Invadesthevisceralpleura

T2T2:Atumorwithanyofthe5T2i)Largerthan3cminlargestdimension

Thislargesquamouscellcarcinomameasures5.4cmintransversedimension.Lineardensitiesradiatetothepleuralsurfacefromthelesion.Thereisafocalpleural-baseddensityidentifiedlaterally(bluearrow),buttheunderlyingsubpleuralfatisnotdisrupted.Thisfindingislikelyduetothedesmoplasticreactionincitedbythetumor.Aspreviouslydiscussed,retractionofthevisceralpleuratowardsthelesionpermitsthedevelopmentofapotentialspacebetweenthevisceralandparietalpleura.Asmallquantityoffluidwithinthespacecanproduceasoft-tissueopacitybetweenthelesionandthepleuralsurface.

T2i)Largerthan3cminlarge6T2ii)Associatedwithatelectasisorpost-obstructivepneumonitisthatextendstothehilarregion,butdoesnotinvolvetheentirelung

Inthispatientwithsquamouscellcarcinoma,thereisanendobronchiallesionattheoriginoftheleftupperlobebronchus(bluearrow).Thereisleftupperlobecollapsewhichhascausedtheleftmainstembronchustoassumeamorehorizontalcourse.Theatelectasisextendstothehilarregion,butdoesnotinvolvetheentireleftlung.T2ii)Associatedwithatelecta7T2iii)Invadesthevisceralpleura

Example1:Thispatientpresentedwitha4.5cmcarcinosarcomaintherightupperlobe.Thelesionabuttedthechestwallalongitssuperiormargin(bluearrows).Atresection,thetumorinvadedthevisceralpleura,buttheparietalpleurahadnoevidenceofinvolvement.

T2iii)Invadesthevisceralpl8T2iii)Invadesthevisceralpleura

Example2:Thisisaninterestingexampleofvisceralpleuralinvasion.Inthiscaseofadenocarcinomatherearethinstandsofdensitywhichareseenradiatingfromthelesiontothepleuralsurfacewherethereisafocalplaque-likesofttissuemass(yellowarrows).Onhistopathologicanalysistherewasvisceralpleuralextensionoftheprimarylesion(makingthelesionT2),butthepleuralsofttissuemassprovedtobefibroustissueandscar.Thus,theprimarylesiondoesnotnecessarilyneedtobeindirectcontactwiththepleuratohaveinvasion.T2iii)Invadesthevisceralpl9T3T3:Atumorofanysizethatdirectlyinvadesanyofthefollowing:thechestwall(includingsuperiorsulcustumors),diaphragm,mediastinalpleura,parietalpericardium;ortumorinthemainbronchuslessthan2cmdistaltothecarina(butwithoutinvolvementofthecarina);ortumorassociatedwithatelectasisorobstructivepneumonitisoftheentirelung.

T3T3:Atumorofanysizethat10T3Example1:T3lesion-chestwallinvasion.Thispatientpresentedwithalonghistoryofshoulderandneckpain.AnabnormalitywasdetectedonCXRandaCTscanconfirmedthepresenceofasuperiorsulcustumor(anadenocarcinoma)associatedwithchestwallinvasionandribdestruction(yellowarrows).Ribinvolvementdoesnotprecludesurgicalresectioninpatientswithsuperiorsulcustumors.

T3Example1:T3lesion-chest11T3Example2:TheT3lesionbelowwasasquamouscellcarcinomaintherightmainbronchusthatwaswithin2cmofthecarina.Thereissomeassociatedrightupperlobeatelectasis.

T3Example2:TheT3lesionbel12T3Example3:T3lesionwithentirelungcollapse.Thispatientwithnon-smallcelllungcancerdemonstratesanabruptcutoffoftheleftmainstembronchus(blackarrows)withcompleteleftlungcollapseduetoalargeendobronchialmass.

T3Example3:T3lesionwithent13T4T4:Atumorofanysizethatinvadesanyofthefollowing:mediastinum,heart,greatvessels,trachea,esophagus,vertebralbody,carina;oranytumorwithamalignantpleuralorpericardialeffusion;orwithsatellitetumornoduleswithintheipsilateralprimary-tumorlobeofthelung.

T4T4:Atumorofanysizethat14T4Example1:Thispatientwithbronchogeniccarcinomahadalargecentralmassthatwasdirectlyinvadingthesuperiorvenacava(yellowarrows).LesionsthatinvadethegreatvesselsareconsideredT4:

T4Example1:Thispatientwith15T4Example2:ThisisanexampleofaT4lesioninapatientwithNSCLCthatwasinvadingathoracicvertebralbody.Theribisalsoinvolved.T4Example2:Thisisanexampl16T4Example3:Thispatientwithadenocarcinomahadalargemasswhichwasobstructingtheleftupperlobebronchuscausingleftupperlobecollapse.ThelargeleftpleuraleffusionwaspositiveformalignantcellsmakingthisaT4lesion.Otherimportantfindingswhichindicatenon-resectabilityinthiscaseincludeencasementoftheleftpulmonaryarterytoit'soriginfromthemainpulmonaryartery.

T4Example3:Thispatientwith17T4Example4:Thispatientwithadenocarcinomaofthesuperiorsegmentoftheleftlowerlobe(yellowarrow)wasalsonotedtohaveastellitenoduleintheipsilateraltumorlobe(whitearrow)adjacenttothemajorfissure.ThisisaT4lesionbyCTstaging.

T4Example4:Thispatientwith18T4Example5:Thispatientwithnon-smallcelllungcancerhadanecrotictumor(M)whichwasinvolvingthecarina(T4lesion).Avirtualbronchoscopicimageisalsoprovided--themassisindicatedbythebluearrows.

T4Example5:Thispatientwith19T4Example6:Thispatienthadasuperiorsulcustumor(yellowarrows)thatwasinvadingintothemediastinum.Notethelossofafatplanebetweenthemassandtheesophagus(whitearrows).Esophagealencasementisdemonstratedonthebariumswallow(blackarrows).ThisisanotherexampleofaT4lesion.

T4Example6:Thispatienthad20

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谢谢！21肺癌的肿瘤分期及CT影像学表现

肺癌的肿瘤分期及CT影像学表现22T1T1:Atumorlessthanorequalto3cmingreatestdimension,surroundedbylungorvisceralpleura,withoutbronchoscopicevidenceofinvasionmoreproximalthanthelobarbronchus(i.e.,notinthemainbronchus).

T1T1:Atumorlessthanorequ23T1Example1:ThisisanexampleofarightlungT1lesion(inthiscaseanadenocarcinoma).Thetumormeasures2.4cminsizeandiscompletelysurroundedbylung.

T1Example1:Thisisanexampl24T1Example2:ThisisanexampleofaT1lesionintheleftlung(thenodulardensityintherightlunganteriorly[bluearrow]istheinferiormarginoftherightclavicularhead).Thetumormeasures1.8cminsizeandiscompletelysurroundedbylung.Athinlineardensityradiatestothepleuralsurfacefromthelesion-thisisreferredtoasa"pleuraltag"whichisfelttorepresenttumor-inducedthickeningoftheinterlobularsepta.Thereisafocaltriangular-shapedpleural-baseddensityidentifiedattheinsertionofthe"pleuraltag"(blackarrow).Thisfindingisfelttobesecondarytothedesmoplasticreactionincitedbythetumor.Thereisretractionofthevisceralpleuratowardsthelesion,andasmallquantityoffluidcollectswithinthespaceformedbetweenthevisceralandparietalpleuraproducingthefindingidentifiedoncomputedtomography.Thefindingdoesnotindicatevisceralpleuralinvasion.

T1Example2:Thisisanexampl25T2T2:Atumorwithanyofthefollowingfeatures:

i)Largerthan3cminlargestdimension

ii)Associatedwithatelectasisorpost-obstructivepneumonitisthatextendstothehilarregion,butdoesnotinvolvetheentirelung

iii)Invadesthevisceralpleura

T2T2:Atumorwithanyofthe26T2i)Largerthan3cminlargestdimension

Thislargesquamouscellcarcinomameasures5.4cmintransversedimension.Lineardensitiesradiatetothepleuralsurfacefromthelesion.Thereisafocalpleural-baseddensityidentifiedlaterally(bluearrow),buttheunderlyingsubpleuralfatisnotdisrupted.Thisfindingislikelyduetothedesmoplasticreactionincitedbythetumor.Aspreviouslydiscussed,retractionofthevisceralpleuratowardsthelesionpermitsthedevelopmentofapotentialspacebetweenthevisceralandparietalpleura.Asmallquantityoffluidwithinthespacecanproduceasoft-tissueopacitybetweenthelesionandthepleuralsurface.

T2i)Largerthan3cminlarge27T2ii)Associatedwithatelectasisorpost-obstructivepneumonitisthatextendstothehilarregion,butdoesnotinvolvetheentirelung

Inthispatientwithsquamouscellcarcinoma,thereisanendobronchiallesionattheoriginoftheleftupperlobebronchus(bluearrow).Thereisleftupperlobecollapsewhichhascausedtheleftmainstembronchustoassumeamorehorizontalcourse.Theatelectasisextendstothehilarregion,butdoesnotinvolvetheentireleftlung.T2ii)Associatedwithatelecta28T2iii)Invadesthevisceralpleura

Example1:Thispatientpresentedwitha4.5cmcarcinosarcomaintherightupperlobe.Thelesionabuttedthechestwallalongitssuperiormargin(bluearrows).Atresection,thetumorinvadedthevisceralpleura,buttheparietalpleurahadnoevidenceofinvolvement.

T2iii)Invadesthevisceralpl29T2iii)Invadesthevisceralpleura

Example2:Thisisaninterestingexampleofvisceralpleuralinvasion.Inthiscaseofadenocarcinomatherearethinstandsofdensitywhichareseenradiatingfromthelesiontothepleuralsurfacewherethereisafocalplaque-likesofttissuemass(yellowarrows).Onhistopathologicanalysistherewasvisceralpleuralextensionoftheprimarylesion(makingthelesionT2),butthepleuralsofttissuemassprovedtobefibroustissueandscar.Thus,theprimarylesiondoesnotnecessarilyneedtobeindirectcontactwiththepleuratohaveinvasion.T2iii)Invadesthevisceralpl30T3T3:Atumorofanysizethatdirectlyinvadesanyofthefollowing:thechestwall(includingsuperiorsulcustumors),diaphragm,mediastinalpleura,parietalpericardium;ortumorinthemainbronchuslessthan2cmdistaltothecarina(butwithoutinvolvementofthecarina);ortumorassociatedwithatelectasisorobstructivepneumonitisoftheentirelung.

T3T3:Atumorofanysizethat31T3Example1:T3lesion-chestwallinvasion.Thispatientpresentedwithalonghistoryofshoulderandneckpain.AnabnormalitywasdetectedonCXRandaCTscanconfirmedthepresenceofasuperiorsulcustumor(anadenocarcinoma)associatedwithchestwallinvasionandribdestruction(yellowarrows).Ribinvolvementdoesnotprecludesurgicalresectioninpatientswithsuperiorsulcustumors.

T3Example1:T3lesion-chest32T3Example2:TheT3lesionbelowwasasquamouscellcarcinomaintherightmainbronchusthatwaswithin2cmofthecarina.Thereissomeassociatedrightupperlobeatelectasis.

T3Example2:TheT3lesionbel33T3Example3:T3lesionwithentirelungcollapse.Thispatientwithnon-smallcelllungcancerdemonstratesanabruptcutoffoftheleftmainstembronchus(blackarrows)withcompleteleftlungcollapseduetoalargeendobronchialmass.

T3Example3:T3lesionwithent34T4T4:Atumorofanysizethatinvadesanyofthefollowing:mediastinum,heart,greatvessels,trachea,esophagus,vertebralbody,carina;oranytumorwithamalignantpleuralorpericardialeffusion;orwithsatellitetumornoduleswithintheipsilateralprimary-tumorlobeofthelung.

T4T4:Atumorofanysizethat35T4Example1:Thispatientwithbronchogeniccarcinomahadalargecentralmassthatwasdirectlyinvadingthesuperiorvenacava(yellowarrows).LesionsthatinvadethegreatvesselsareconsideredT4:

T4Example1:Thispatientwith36T4Example2:ThisisanexampleofaT4lesion