肺癌分期PET課件

1、肺癌分期PET,1,肺癌新分期的影像學(xué)表現(xiàn)及 PET/CT在分期中的價(jià)值和挑戰(zhàn),Marvin H. Chasen, 醫(yī)學(xué)博士, 環(huán)境衛(wèi)生學(xué)碩士, 美國放射性學(xué)會(huì)會(huì)員,肺癌分期PET,2,目 的,1997年TNM分期改動(dòng)介紹,a. 胸壁侵犯 (T3,b. 同側(cè)及對(duì)側(cè) (N3,c. 范圍 (N2 vs. N3, M1,什么原因產(chǎn)生了這些變化？（新統(tǒng)計(jì)數(shù)據(jù),a. 沒有特異性,缺陷,b. 實(shí)用性問題,c. 不可預(yù)期情況,肺癌分期PET,3,非小細(xì)胞肺癌,1997早期標(biāo)準(zhǔn),原發(fā)灶 (T1, T2, T3, T4,區(qū)域淋巴結(jié) (N0, N1, N2, N3,遠(yuǎn)處轉(zhuǎn)移 (M0, M1,肺癌分期PET,4,修

2、訂后標(biāo)準(zhǔn),國際肺癌研究協(xié)會(huì),T1,a 2cm,b 2cm to 3cm,T2,a 3cm to 5cm,b 5cm to 7cm,T3,7cm,原發(fā)灶同一肺葉出現(xiàn)衛(wèi)星結(jié)節(jié),T4,同側(cè)不同肺葉出現(xiàn)衛(wèi)星結(jié)節(jié),Rami Porta et al. The IASLC Lung Cancer Staging Project: Proposals for the Revision,of the T descriptors in the Forthcoming (Seventh) Edition of the TNM Classification,for Lung Cancer. J Thorac Onco

3、l 2007;2:593-602,肺癌分期PET,5,非小細(xì)胞肺癌,TNM 分期,T1-早期標(biāo)準(zhǔn),原發(fā)灶 3 cm,周圍被肺及臟層胸膜包繞,氣管鏡下侵犯沒有超出葉支氣管,T1-新標(biāo)準(zhǔn),a 2cm,b 2cm to 3cm,肺癌分期PET,6,T1,T1a, 2cm,肺癌分期PET,7,修訂后標(biāo)準(zhǔn),國際肺癌研究協(xié)會(huì),T1,a 2cm,b 2cm to 3cm,T2,a 3cm to 5cm,b 5cm to 7cm,T3,7cm,原發(fā)灶同一肺葉出現(xiàn)衛(wèi)星結(jié)節(jié),T4,同側(cè)不同肺葉出現(xiàn)衛(wèi)星結(jié)節(jié),Rami Porta et al. The IASLC Lung Cancer Staging Projec

4、t: Proposals for the Revision,of the T descriptors in the Forthcoming (Seventh) Edition of the TNM Classification,for Lung Cancer. J Thorac Oncol 2007;2:593-602,肺癌分期PET,8,非小細(xì)胞肺癌,TNM 分期,T2 早期標(biāo)準(zhǔn),原發(fā)灶 3 cm,主支氣管侵犯，但距隆突2cm,肺不張或阻塞性肺炎少于一側(cè)肺,侵犯臟層胸膜,T2 新標(biāo)準(zhǔn),a 3cm to 5cm,b 5cm to 7cm,肺癌分期PET,9,T2,T2a,3cm to 5cm,

5、肺癌分期PET,10,修訂后標(biāo)準(zhǔn),國際肺癌研究協(xié)會(huì),T1,a 2cm,b 2cm to 3cm,T2,a 3cm to 5cm,b 5cm to 7cm,T3,7cm,原發(fā)灶同一肺葉出現(xiàn)衛(wèi)星結(jié)節(jié),T4,同側(cè)不同肺葉出現(xiàn)衛(wèi)星結(jié)節(jié),Rami Porta et al. The IASLC Lung Cancer Staging Project: Proposals for the Revision,of the T descriptors in the Forthcoming (Seventh) Edition of the TNM Classification,for Lung Cancer. J

6、 Thorac Oncol 2007;2:593-602,肺癌分期PET,11,T2,T2b,5cm to 7cm,測量誤差,肺癌分期PET,12,T2,T3,7cm,肺癌分期PET,13,修訂后標(biāo)準(zhǔn),國際肺癌研究協(xié)會(huì),T1,a 2cm,b 2cm to 3cm,T2,a 3cm to 5cm,b 5cm to 7cm,T3,7cm,原發(fā)灶同一肺葉出現(xiàn)衛(wèi)星結(jié)節(jié),T4,同側(cè)不同肺葉出現(xiàn)衛(wèi)星結(jié)節(jié),Rami Porta et al. The IASLC Lung Cancer Staging Project: Proposals for the Revision,of the T descripto

7、rs in the Forthcoming (Seventh) Edition of the TNM Classification,for Lung Cancer. J Thorac Oncol 2007;2:593-602,肺癌分期PET,14,非小細(xì)胞肺癌,TNM 分期,T2,其它標(biāo)準(zhǔn),主支氣管侵犯，但距隆突2cm,肺不張或阻塞性肺炎少于一側(cè)肺,侵犯臟層胸膜,肺癌分期PET,15,T2,阻塞性肺炎少于一側(cè)肺,距隆突 2cm,肺癌分期PET,16,T2,侵犯臟層胸膜（手術(shù)證實(shí),肺癌分期PET,17,非小細(xì)胞肺癌,TNM 分期,T3 (其它標(biāo)準(zhǔn),全肺不張或阻塞性肺炎,胸壁侵犯,距離隆突2cm，

8、但未及隆突,侵犯縱隔胸膜、膈神經(jīng)或心包,肺癌分期PET,18,T3,全肺不張,肺癌分期PET,19,T3,均侵犯胸壁,與大小無關(guān)（箭頭,哪一個(gè)侵犯了縱隔,肺癌分期PET,20,非小細(xì)胞肺癌,TNM 分期,T4-早期標(biāo)準(zhǔn),侵犯椎體，大氣管、食管、縱隔、隆突等,同側(cè)不同肺葉出現(xiàn)衛(wèi)星結(jié)節(jié),惡性積液,肺癌分期PET,21,T4,椎體侵犯,肺癌分期PET,22,T4,MRI,侵入左心房,不僅通過縱隔胸膜,肺癌分期PET,23,T4,CT,侵犯左心房,與原發(fā)灶大小無關(guān)- 見箭頭,肺癌分期PET,24,非小細(xì)胞肺癌,TNM 分期,T4-早期標(biāo)準(zhǔn),侵犯椎體，大氣管、食管、縱隔、隆突等,同側(cè)不同肺葉出現(xiàn)衛(wèi)星結(jié)節(jié)

9、,惡性積液,肺癌分期PET,25,T4,M1a,惡性積液,胸腔或心包,肺癌分期PET,26,非小細(xì)胞肺癌,TNM 分期,T4-早期標(biāo)準(zhǔn),侵犯椎體，大氣管、食管、縱隔、隆突等,同側(cè)不同肺葉出現(xiàn)衛(wèi)星結(jié)節(jié),惡性積液,肺癌分期PET,27,T4,T3,同側(cè)肺葉結(jié)節(jié),肺癌分期PET,28,修訂后標(biāo)準(zhǔn),國際肺癌研究協(xié)會(huì),T1,a 2cm,b 2cm to 3cm,T2,a 3cm to 5cm,b 5cm to 7cm,T3,7cm,原發(fā)灶同一肺葉出現(xiàn)衛(wèi)星結(jié)節(jié),T4,同側(cè)不同肺葉出現(xiàn)衛(wèi)星結(jié)節(jié),Rami Porta et al. The IASLC Lung Cancer Staging Project:

10、Proposals for the Revision,of the T descriptors in the Forthcoming (Seventh) Edition of the TNM Classification,for Lung Cancer. J Thorac Oncol 2007;2:593-602,肺癌分期PET,29,T4,T3,T4? (同一肺葉還是不同肺葉,肺癌分期PET,30,NSCLC 分期,區(qū)域淋巴結(jié)情況,N0,無區(qū)域淋巴結(jié)轉(zhuǎn)移,N1,同側(cè)支氣管或肺門淋巴結(jié)轉(zhuǎn)移,N2,同側(cè)縱隔和/或隆突下淋巴結(jié)轉(zhuǎn)移,N3,對(duì)側(cè)縱隔和/或?qū)?cè)肺門，和/或同側(cè)或?qū)?cè)前斜角肌或鎖骨上淋巴

11、結(jié)轉(zhuǎn)移,肺癌分期PET,31,淋巴結(jié)分布,肺癌分期PET,32,Radiologists may report TNM status but not usually actual stage as it may change with,further analysis (e.g., with biopsy/surgery pathology,肺癌分期PET,33,PET/CT 在分期中的價(jià)值,肺癌,左鎖骨上淋巴結(jié)轉(zhuǎn)移,IIIb 期(任何 T, N3,CT箭頭所示,肺癌分期PET,34, N2-Malignant vs. benign lymph node,良性還是惡性,活檢證實(shí)為感染所致炎癥性

12、攝?。^,并非所有FDG高代謝均為惡性,肺癌分期PET,35,NSCLC 分期,遠(yuǎn)處轉(zhuǎn)移情況,早期標(biāo)準(zhǔn),M0,無遠(yuǎn)處轉(zhuǎn)移,M1,有遠(yuǎn)處轉(zhuǎn)移,非原發(fā)灶所在肺葉出現(xiàn)衛(wèi)星結(jié)節(jié),肺癌分期PET,36,修訂后標(biāo)準(zhǔn),M1a,惡性胸腔或心包積液,惡性胸膜結(jié)節(jié),對(duì)側(cè)肺內(nèi)轉(zhuǎn)移結(jié)節(jié),M1b,遠(yuǎn)處轉(zhuǎn)移,Postmus P et al. The IASLC Lung Cancer Staging Project: Proposals for the,Revision of the M descriptors in the Forthcoming (Seventh) Edition of the TNM,Classi

13、fication for Lung Cancer: J Thorac Oncol 2007;2:686-693,肺癌分期PET,37,T4,M1a,惡性積液,胸腔或心包,肺癌分期PET,38,修訂后標(biāo)準(zhǔn),M1a,惡性胸腔或心包積液,惡性胸膜結(jié)節(jié),對(duì)側(cè)肺內(nèi)轉(zhuǎn)移結(jié)節(jié),M1b,遠(yuǎn)處轉(zhuǎn)移,Postmus P et al. The IASLC Lung Cancer Staging Project: Proposals for the,Revision of the M descriptors in the Forthcoming (Seventh) Edition of the TNM,Classif

14、ication for Lung Cancer: J Thorac Oncol 2007;2:686-693,肺癌分期PET,39,肺癌 M1,M1a,對(duì)側(cè)肺內(nèi)結(jié)節(jié),轉(zhuǎn)移還是原發(fā),肺癌分期PET,40,PET/CT診斷遠(yuǎn)處轉(zhuǎn)移的價(jià)值,左側(cè)腎上腺無放射性異常攝取（箭頭,肺癌,肺癌分期PET,41,Adrenal M1,M1b,PET/CT冠狀位成像,CT示左側(cè)腎上腺侵犯 (箭頭,左側(cè)腎上腺轉(zhuǎn)移(箭頭,肺癌分期PET,42,腎上腺 M1,M1b,肺 癌,肺癌分期PET,43,腎上腺 M1,M1b,肺 癌,正常大小的腎上腺轉(zhuǎn)移（箭頭,肺癌分期PET,44,腦 M1,M1b,肺癌分期PET,45,骨 M1,M1b,肺癌(長箭頭) 骨轉(zhuǎn)移(短箭頭,肺癌分期PET,46,Radiologists may report TNM status but no