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Approaching to clinically T4 tumours

Approaching to clinically T4 tumours. Dr Murat Kıyık. AJCC/UICC 1997 :STAGING T4. Mediastinal invasion Great vessel invasion Cardiac invasion Tracheal inv. Carinal inv. Eosophageal inv. Vertebral body inv. Malign Pleural effusion Malign Pericardial effusion

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Approaching to clinically T4 tumours

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  1. Approaching to clinically T4 tumours Dr Murat Kıyık

  2. AJCC/UICC 1997 :STAGINGT4 • Mediastinal invasion • Great vessel invasion • Cardiac invasion • Tracheal inv. • Carinal inv. • Eosophageal inv. • Vertebral body inv. • Malign Pleural effusion • Malign Pericardial effusion • Satellit nodules in the same lobe with primary tumour

  3. Symptoms and signs • Chest pain • Wheezing and stridor • Dysphagia • Hoarseness • Superior venae cava syndrom • Pleural effusion • Pericardial effusion

  4. J Thorac Oncol 2007;2:593-602

  5. REVISION OF T4 : IASLC 2007 • Mediastinal invasion • Great vessel invasion • Cardiac invasion • Tracheal inv. • Carinal inv. • Eosophageal inv. • Vertebral body inv. • Malign Pleural effusion • Malign Pericardial effusion • Satellit nodules in the same lobe with primary tumour Rami-Porta R. et al.J Thorac Oncol 2007;2:593-602

  6. Satellite Nodules in the same lobe P=0.28 T4 T3

  7. Unilateral Satellite Nodules in different lobes p=0.41 M1T4

  8. Malign Pleural Effusion p=0.0001 T4 M1

  9. Frequency of T4 ( N0-3M0) Rami-Porta R. et al.J Thorac Oncol 2007;2:593-602

  10. Frequency of T4 (N0M0) Rami-Porta R. et al.J Thorac Oncol 2007;2:593-602

  11. Techniques in staging of T4 • Noninvasive/Radiological • Chest X ray • Thorax CT • Thorax MRI • PET • Minimally invasive • FOB • Laryngeal examination • Tracheal/Carinal byopsy • Thorasynthesis/Pleural byopsy • TEE (transeosophageal echocardiography) • Invasive • Mediastinotomy • VATS • Thorachotomy

  12. Resectability evaluation : CT Glazer HS et al Radiology 1989

  13. CT findings of mediastinal invasion Herman SJ et al. Radiology 1994

  14. Exclusion of mediastinal invasion with CT findings • 3 cm mediastinal contact of mass • Prevention of fatty plan • < 90° aortical contact of mass

  15. Mediastinal invasion criteria with Thorax CT • 180° mediastinal contact of mass • presence of intraluminal tumour in mediastinal structures

  16. Mediastinal InvasionThorax CT  MRI • *Radiology 1991 • **MAGMA 1996 • ***ERS Kongresi 2006

  17. 36 years-old male

  18. Difficulties in evaluating mediastinal invasion with CT and MRI • Motion artefacts • Fibrosis • Reactive inflammatory changes • Athelectasies • Obstructive pneumonaie

  19. TEE to evaluate aortical invasion Schröder C.et al Chest 2005;127:438-442

  20. pT4 (12 cases) TEEThorax CT

  21. THANK YOU…

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