Bilan d’extension du cancer bronchique et classification TNM des CBNPC: Disease extent assessment in lung cancer and TNM classification for Non Small Cell Lung Cancer

Abstract

The definitive diagnosis of lung cancer relies on pathological examination. Tissue samples (by biopsy), or cell samples (by washing, cytopuncture) are collected from the tumor, associated lymphadenopathy or from an accessible metastatic site. There are different methods of diagnostic access to an opacity suspect of bronchial cancer. Guidelines have been published for each of the techniques in order to maximize their diagnostic efficiency and to allow or immunohistochemical or molecular analyses that modify the therapeutic strategy. The first objective of this topic is to describe the different diagnostic methods and to suggest ways to optimize the diagnosis of broncho-pulmonary cancers.Establishing cTNM relies on a precise and rigorous evaluation. The second objective of this article is to present the modalities of NSCLC extension assessment, addressing the indications of imaging exams as well as their limitations. SCLC management is discussed in a specific chapter. Clinical examination remains essential. Chest Computed- Tomography (CT) scan with iodine contrast injection is systematic, unless contraindicated. The size of the tumor, its pleural, parietal, endobronchial and direct mediastinal extension should be specified as well as the lymph node extension. 18FDG PET-CT is not indicated as a first line but is essential in patients potentially eligible for curative treatment. Brain imaging is indicated, even in asymptomatic patients. Compliance with the recommendations and proper organisation optimise management of patients.The international TNM classification, accepted by both UICC and AJCC, is routinely used for non-small cell lung cancer management. The aim of this article is to review the 8th TNM classification, its practical implications and the IASLC Staging Committee proposals regarding some specific clinical situations. The new database that will inform the ninth TNM classification is discribed awiating publication of the next revision.1877-1203/© 2023 SPLF. Published by Elsevier Masson SAS. All rights reserved.