肺癌肿瘤分期与CT影像学表现

T1T1:Atumorlessthanorequalto3cmingreatestdimension,surroundedbylungorvisceralpleura,withoutbronchoscopicevidenceofinvasionmoreproximalthanthelobarbronchus(i.e.,notinthemainbronchus).

第一页，共20页。T1Example1:ThisisanexampleofarightlungT1lesion(inthiscaseanadenocarcinoma).Thetumormeasures2.4cminsizeandiscompletelysurroundedbylung.

第二页，共20页。T1Example2:ThisisanexampleofaT1lesionintheleftlung(thenodulardensityintherightlunganteriorly[bluearrow]istheinferiormarginoftherightclavicularhead).Thetumormeasures1.8cminsizeandiscompletelysurroundedbylung.Athinlineardensityradiatestothepleuralsurfacefromthelesion-thisisreferredtoasa"pleuraltag"whichisfelttorepresenttumor-inducedthickeningoftheinterlobularsepta.Thereisafocaltriangular-shapedpleural-baseddensityidentifiedattheinsertionofthe"pleuraltag"(blackarrow).Thisfindingisfelttobesecondarytothedesmoplasticreactionincitedbythetumor.Thereisretractionofthevisceralpleuratowardsthelesion,andasmallquantityoffluidcollectswithinthespaceformedbetweenthevisceralandparietalpleuraproducingthefindingidentifiedoncomputedtomography.Thefindingdoesnotindicatevisceralpleuralinvasion.

第三页，共20页。T2T2:Atumorwithanyofthefollowingfeatures:

i)Largerthan3cminlargestdimension

ii)Associatedwithatelectasisorpost-obstructivepneumonitisthatextendstothehilarregion,butdoesnotinvolvetheentirelung

iii)Invadesthevisceralpleura

第四页，共20页。T2i)Largerthan3cminlargestdimension

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

第五页，共20页。T2ii)Associatedwithatelectasisorpost-obstructivepneumonitisthatextendstothehilarregion,butdoesnotinvolvetheentirelung

Inthispatientwithsquamouscellcarcinoma,thereisanendobronchiallesionattheoriginoftheleftupperlobebronchus(bluearrow).Thereisleftupperlobecollapsewhichhascausedtheleftmainstembronchustoassumeamorehorizontalcourse.Theatelectasisextendstothehilarregion,butdoesnotinvolvetheentireleftlung.第六页，共20页。T2iii)Invadesthevisceralpleura

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

第七页，共20页。T2iii)Invadesthevisceralpleura

Example2:Thisisaninterestingexampleofvisceralpleuralinvasion.Inthiscaseofadenocarcinomatherearethinstandsofdensitywhichareseenradiatingfromthelesiontothepleuralsurfacewherethereisafocalplaque-likesofttissuemass(yellowarrows).Onhistopathologicanalysistherewasvisceralpleuralextensionoftheprimarylesion(makingthelesionT2),butthepleuralsofttissuemassprovedtobefibroustissueandscar.Thus,theprimarylesiondoesnotnecessarilyneedtobeindirectcontactwiththepleuratohaveinvasion.第八页，共20页。T3T3:Atumorofanysizethatdirectlyinvadesanyofthefollowing:thechestwall(includingsuperiorsulcustumors),diaphragm,mediastinalpleura,parietalpericardium;ortumorinthemainbronchuslessthan2cmdistaltothecarina(butwithoutinvolvementofthecarina);ortumorassociatedwithatelectasisorobstructivepneumonitisoftheentirelung.

第九页，共20页。T3Example1:T3lesion-chestwallinvasion.Thispatientpresentedwithalonghistoryofshoulderandneckpain.AnabnormalitywasdetectedonCXRandaCTscanconfirmedthepresenceofasuperiorsulcustumor(anadenocarcinoma)associatedwithchestwallinvasionandribdestruction(yellowarrows).Ribinvolvementdoesnotprecludesurgicalresectioninpatientswithsuperiorsulcustumors.

第十页，共20页。T3Example2:TheT3lesionbelowwasasquamouscellcarcinomaintherightmainbronchusthatwaswithin2cmofthecarina.Thereissomeassociatedrightupperlobeatelectasis.

第十一页，共20页。T3Example3:T3lesionwithentirelungcollapse.Thispatientwithnon-smallcelllungcancerdemonstratesanabruptcutoffoftheleftmainstembronchus(blackarrows)withcompleteleftlungcollapseduetoalargeendobronchialmass.

第十二页，共20页。T4T4:Atumorofanysizethatinvadesanyofthefollowing:mediastinum,heart,greatvessels,trachea,esophagus,vertebralbody,carina;oranytumorwithamalignantpleuralorpericardialeffusion;orwithsatellitetumornoduleswithintheipsilateralprimary-tumorlobeofthelung.

第十三页，共20页。T4Example1:Thispatientwithbronchogeniccarcinomahadalargecentralmassthatwasdirectlyinvadingthesuperiorvenacava(yellowarrows).LesionsthatinvadethegreatvesselsareconsideredT4:

第十四页，共20页。T4Example2:ThisisanexampleofaT4lesioninapatientwithNSCLCthatwasinvadingathoracicvertebralbody.Theribisalsoinvolved.第十五页，共20页。T4Example3:Thispatientwithadenocarcinomahadalargemasswhichwasobstructingtheleftupperlobebronchuscausingleftupperlobecollapse.ThelargeleftpleuraleffusionwaspositiveformalignantcellsmakingthisaT4lesion.Otherimportantfindingswhichindicatenon-resectabilityinthiscaseincludeencasementoftheleftpulmonaryarterytoit'soriginfromthemainpulmonaryartery.

第十六页，共20页。T4Example4:Thispatientwithadenocarcinomaofthesuperiorsegmentoftheleftlowerlobe(yellowarrow)wasalsonotedtohaveastellitenodulein