Staging of Lung Cancer

Abstract

Introduction Thoracic imaging is pivotal in the evaluation of patients with lung cancer. As with most other cancers, treatment options and outcomes are dependent on stage and cell type. Uniform criteria for reporting the findings of clinical and/or pathological evaluation are important in the initial management of patients with non-small cell lung cancer (NSCLC) and consequently all patients with NSCLC are typically staged before therapy according to the recommendations of the International Staging System for Lung Cancer. The treatment of choice for NSCLC, in the absence of disseminated disease is surgical resection. The primary aim of staging is thus to determine whether a tumour can be completely removed by surgery; clear surgical margins in resection specimens and the absence of tumour cells in resected lymph nodes being the prime determinants of local recurrence and survival. The aim of this chapter is to review the role of imaging in staging lung cancer, focusing on CT (currently, the main imaging modality used in staging) and MRI. For the sake of completeness the technique of position emission tomography (PET) will be referred to but this imaging modality is covered comprehensively elsewhere in this volume. International Staging System (TNM Staging) for Lung Cancer Before considering the role of imaging tests in staging, it is worth reminding the reader about the International Staging System for lung cancer.