MS09.02 Cases Prepared by Drs. Edell/Murgu

Abstract

Lung cancer remains the leading cause of cancer-related mortality worldwide. In order to provide adequate and appropriate treatment, staging is crucial. The TNM staging system is the established uniform method of staging lung cancer, both non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). The revised classification of the most recent edition (TNM-8) of the TNM staging system, proposed by the International Association for the Study of Lung Cancer (IASLC) and introduced in 2016, is based on detailed analysis of a new large international database of almost 78000 lung cancer cases from 16 countries. The first part of this talk will focus on tissue diagnosis, specifically CT-guided core biopsy. In the era of targeted therapies and customized treatment, the acquisition of an adequate and representative sample, especially in non-surgical patients, is pivotal. Complications, pitfalls and pearls of CT-guided lung biopsies will be addressed. The second part of the talk will be focussing on the changes between TNM-7 and TNM-8 – downstaging of lung atelectasis and pneumonitis, upstaging of diaphragmatic invasion, reclassification of extra-thoracic metastatic disease; the IASLC recommends that radiologists should document the number of metastatic lesions, the diameter of individual metastatic lesions and the number of involved organs at staging examinations. The conundrum relating to nodal staging with CT and FDG-PET imaging will be explored. Lung cancer with multiple sites of pulmonary involvement – multiple primary lung cancers, lung cancer with separate tumour nodules, multiple ground glass/lepidic lesions and lung cancer manifesting as consolidation - will be discussed.