Réplica

Diagnosing and Staging Lung Cancer Involving the Mediastinum

“…2,6,7 Normal and Pathologic Mediastinum on CT Scan and PET Scan: Implications for Staging Contrast-enhanced chest and upper abdominal CT scan is recommended as an initial step for all patients with suspected or confi rmed diagnosis of lung cancer suitable for treatment. [7][8][9][10] Th e revised IASLC system is clinician oriented and should be used for staging, 8 as it unifi es previously used systems and defi nes the borders of the mediastinal, hilar, and interlobar lymph nodes based on CT scan landmarks. 11 To further help clinicians in their routine practice, the American College of Chest Physicians proposed that patients with lung cancer be separated into four categories with respect to the radiographic characteristics of the primary tumor and the lymph nodes based on CT scan fi ndings 12 ( Fig 1 ) .…”

“…13 Spanish Society for Pulmonology and Th oracic Surgery (SEPAR) guidelines recommend invasive staging in patients with low metabolic activity in the primary tumors, as in some adenocarcinomas, since these tumors may be associated with occult N2 disease (ie, pathologic involvement with a negative CT scan and PET scan). 8 Th e term "normal mediastinum" by CT scan criteria is used to defi ne the absence of visualized mediastinal lymph nodes or the presence of nonpathologic-size lymph nodes. CT scan criteria have been used to defi ne the probability of malignant involvement of the mediastinal lymph nodes.…”

“…SEPAR defi nes these as nodes whose smallest diameter is . 15 mm on CT scan with contrast, 8 whereas National Institute for Health and Care Excellence defi nes them as lymph nodes between 10 and 20 mm maximum short axis on CT scan. 10 Overall, however, the median sensitivity and specifi city of CT scanning for identifying mediastinal lymph node metastasis are 55% and 81%, respectively ( Table 1 ) .…”

“…PET scanning also provides information regarding metastatic disease outside the thorax, except for the brain. [7][8][9][10] Guidelines recommend the use of PET scan and PET-CT scan for staging in patients who are potential candidates for radical treatment (clinical stage IA-IIIA). 7,8,10…”

“…12 In the absence of M1 extrathoracic disease, a PET scan showing hypermetabolism in the mediastinal nodes requires confi rmation. 2,[7][8][9][10]19 If the PET scan is negative, tissue confi rmation is recommended prior to surgery in any of the following circumstances ( Fig 1 ):…”