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Metastatic involvement (M). M0 - No metastases M1 - Metastases present. Metastases (M). M0: No distant metastasis M1: Distant metastasis present; or
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Metastatic involvement (M) • M0 - No metastases • M1 - Metastases present
Metastases (M) • M0: No distant metastasis • M1: Distant metastasis present; or Separate tumor nodules in the ipsilateralnonprimary-tumor lobes of the lung. Separate tumor nodules in the contralateral lung are considered M1 if they are of the same histologic cell type as the primary lesion. A contralateral lung tumor with a different cell type is considered a synchronous primary lesion and should be staged independently
Advantages MRI has over CT in Tumor assessment • Mediastinal and chest wall invasion and involvement of the diaphragm. • MRI is most useful when evaluating spinal cord compression and brain metastasis . • In Pancoast tumours, invasion into the brachial plexus, subclavian artery or vertebral body by MRI has been found to be 94% accurate as opposed to 63% for CT .
Positron Emission Tomography • PET scans appear to be more sensitive, specific, and accurate than CT scans for staging mediastinal disease. • PET is more accurate than conventional studies in detecting recurrent lung cancer. • False-positive studies do occur secondary to postirradiation inflammatory change and delaying the examination until 4 or 5 weeks postirradiation is recommended
The solitary pulmonary nodule • A common incidental CXR finding . • CT detects many more lung nodules than CXR. • Numerous differential diagnoses. • 50% are malignant: 40% are primary CA, 10% are solitary metastases . • Prompt diagnosis and management of early lung cancer manifesting as SPN may be the only chance for cure. • No significant mortality reduction with screening.
Calcification in SPN • CT scanning can further refine the detection of calcification and fat within nodules. A total 22–38% of noncalcified nodules on chest radiographs appear calcified on CT. • Eccentric or stippled calcification is seen in 10% of lung cancers.
Features of SPN suggesting benignity • Clinical history, especially of T.B. • Compared with old films,no growth over a 2-yr period. • Age <35 yrs, • No history of cigarette smoking. • No history of extrathoracic malignancy .
