肺癌的肿瘤分期及C影像学表现

肺癌的肿瘤分期及CT影像学表现

南方医科大学第一临床医学院

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

T1Example1:ThisisanexampleofarightlungT1lesion(inthiscaseanadenocarcinoma).Thetumormeasures2.4cminsizeandiscompletelysurroundedbylung.

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

T2T2:Atumorwithanyofthefollowingfeatures:

i)Largerthan3cminlargestdimension

ii)Associatedwithatelectasisorpost-obstructivepneumonitisthatextendstothehilarregion,butdoesnotinvolvetheentirelung

iii)Invadesthevisceralpleura

T2i)Largerthan3cminlargestdimension

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

T2ii)Associatedwithatelectasisorpost-obstructivepneumonitisthatextendstothehilarregion,butdoesnotinvolvetheentirelung

Inthispatientwithsquamouscellcarcinoma,thereisanendobronchiallesionattheoriginoftheleftupperlobebronchus(bluearrow).Thereisleftupperlobecollapsewhichhascausedtheleftmainstembronchustoassumeamorehorizontalcourse.Theatelectasisextendstothehilarregion,butdoesnotinvolvetheentireleftlung.T2iii)Invadesthevisceralpleura

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

T2iii)Invadesthevisceralpleura

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

T3Example1:T3lesion-chestwallinvasion.Thispatientpresentedwithalonghistoryofshoulderandneckpain.AnabnormalitywasdetectedonCXRandaCTscanconfirmedthepresenceofasuperiorsulcustumor(anadenocarcinoma)associatedwithchestwallinvasionandribdestruction(yellowarrows).Ribinvolvementdoesnotprecludesurgicalresectioninpatientswithsuperiorsulcustumors.

T3Example2:TheT3lesionbelowwasasquamouscellcarcinomaintherightmainbronchusthatwaswithin2cmofthecarina.Thereissomeassociatedrightupperlobeatelectasis.

T3Example3:T3lesionwithentirelungcollapse.Thispatientwithnon-smallcelllungcancerdemonstratesanabruptcutoffoftheleftmainstembronchus(blackarrows)withcompleteleftlungcollapseduetoalargeendobronchialmass.

T4T4:Atumorofanysizethatinvadesanyofthefollowing:mediastinum,heart,greatvessels,trachea,esophagus,vertebralbody,carina;oranytumorwithamalignantpleuralorpericardialeffusion;orwithsatellitetumornoduleswithintheipsilateralprimary-tumorlobeofthelung.

T4Example1:Thispatientwithbronchogeniccarcinomahadalargecentralmassthatwasdirectlyinvadingthesuperiorvenacava(yellowarrows).LesionsthatinvadethegreatvesselsareconsideredT4:

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