肺癌的腫瘤分期及CT影像學表現(xiàn)課件

肺癌的腫瘤分期及CT影像學表現(xiàn)

南方醫(yī)科大學第一臨床醫(yī)學院

肺癌的腫瘤分期及CT影像學表現(xiàn)T1T1:Atumorlessthanorequalto3cmingreatestdimension,surroundedbylungorvisceralpleura,withoutbronchoscopicevidenceofinvasionmoreproximalthanthelobarbronchus(i.e.,notinthemainbronchus).

肺癌的腫瘤分期及CT影像學表現(xiàn)T1Example1:ThisisanexampleofarightlungT1lesion(inthiscaseanadenocarcinoma).Thetumormeasures2.4cminsizeandiscompletelysurroundedbylung.

肺癌的腫瘤分期及CT影像學表現(xiàn)T1Example2:ThisisanexampleofaT1lesionintheleftlung(thenodulardensityintherightlunganteriorly[bluearrow]istheinferiormarginoftherightclavicularhead).Thetumormeasures1.8cminsizeandiscompletelysurroundedbylung.Athinlineardensityradiatestothepleuralsurfacefromthelesion-thisisreferredtoasa"pleuraltag"whichisfelttorepresenttumor-inducedthickeningoftheinterlobularsepta.Thereisafocaltriangular-shapedpleural-baseddensityidentifiedattheinsertionofthe"pleuraltag"(blackarrow).Thisfindingisfelttobesecondarytothedesmoplasticreactionincitedbythetumor.Thereisretractionofthevisceralpleuratowardsthelesion,andasmallquantityoffluidcollectswithinthespaceformedbetweenthevisceralandparietalpleuraproducingthefindingidentifiedoncomputedtomography.Thefindingdoesnotindicatevisceralpleuralinvasion.

肺癌的腫瘤分期及CT影像學表現(xiàn)T2T2:Atumorwithanyofthefollowingfeatures:

i)Largerthan3cminlargestdimension

ii)Associatedwithatelectasisorpost-obstructivepneumonitisthatextendstothehilarregion,butdoesnotinvolvetheentirelung

iii)Invadesthevisceralpleura

肺癌的腫瘤分期及CT影像學表現(xiàn)T2i)Largerthan3cminlargestdimension

Thislargesquamouscellcarcinomameasures5.4cmintransversedimension.Lineardensitiesradiatetothepleuralsurfacefromthelesion.Thereisafocalpleural-baseddensityidentifiedlaterally(bluearrow),buttheunderlyingsubpleuralfatisnotdisrupted.Thisfindingislikelyduetothedesmoplasticreactionincitedbythetumor.Aspreviouslydiscussed,retractionofthevisceralpleuratowardsthelesionpermitsthedevelopmentofapotentialspacebetweenthevisceralandparietalpleura.Asmallquantityoffluidwithinthespacecanproduceasoft-tissueopacitybetweenthelesionandthepleuralsurface.

肺癌的腫瘤分期及CT影像學表現(xiàn)T2ii)Associatedwithatelectasisorpost-obstructivepneumonitisthatextendstothehilarregion,butdoesnotinvolvetheentirelung

Inthispatientwithsquamouscellcarcinoma,thereisanendobronchiallesionattheoriginoftheleftupperlobebronchus(bluearrow).Thereisleftupperlobecollapsewhichhascausedtheleftmainstembronchustoassumeamorehorizontalcourse.Theatelectasisextendstothehilarregion,butdoesnotinvolvetheentireleftlung.肺癌的腫瘤分期及CT影像學表現(xiàn)T2iii)Invadesthevisceralpleura

Example1:Thispatientpresentedwitha4.5cmcarcinosarcomaintherightupperlobe.Thelesionabuttedthechestwallalongitssuperiormargin(bluearrows).Atresection,thetumorinvadedthevisceralpleura,buttheparietalpleurahadnoevidenceofinvolvement.

肺癌的腫瘤分期及CT影像學表現(xiàn)T2iii)Invadesthevisceralpleura

Example2:Thisisaninterestingexampleofvisceralpleuralinvasion.Inthiscaseofadenocarcinomatherearethinstandsofdensitywhichareseenradiatingfromthelesiontothepleuralsurfacewherethereisafocalplaque-likesofttissuemass(yellowarrows).Onhistopathologicanalysistherewasvisceralpleuralextensionoftheprimarylesion(makingthelesionT2),butthepleuralsofttissuemassprovedtobefibroustissueandscar.Thus,theprimarylesiondoesnotnecessarilyneedtobeindirectcontactwiththepleuratohaveinvasion.肺癌的腫瘤分期及CT影像學表現(xiàn)T3T3:Atumorofanysizethatdirectlyinvadesanyofthefollowing:thechestwall(includingsuperiorsulcustumors),diaphragm,mediastinalpleura,parietalpericardium;ortumorinthemainbronchuslessthan2cmdistaltothecarina(butwithoutinvolvementofthecarina);ortumorassociatedwithatelectasisorobstructivepneumonitisoftheentirelung.

肺癌的腫瘤分期及CT影像學表現(xiàn)T3Example1:T3lesion-chestwallinvasion.Thispatientpresentedwithalonghistoryofshoulderandneckpain.AnabnormalitywasdetectedonCXRandaCTscanconfirmedthepresenceofasuperiorsulcustumor(anadenocarcinoma)associatedwithchestwallinvasionandribdestruction(yellowarrows).Ribinvolvementdoesnotprecludesurgicalresectioninpatientswithsuperiorsulcustumors.

肺癌的腫瘤分期及CT影像學表現(xiàn)T3Example2:TheT3lesionbelowwasasquamouscellcarcinomaintherightmainbronchusthatwaswithin2cmofthecarina.Thereissomeassociatedrightupperlobeatelectasis.

肺癌的腫瘤分期及CT影像學表現(xiàn)T3Example3:T3lesionwithentirelungcollapse.Thispatientwithnon-smallcelllungcancerdemonstratesanabruptcutoffoftheleftmainstembronchus(blackarrows)withcompleteleftlungcollapseduetoalargeendobronchialmass.

肺癌的腫瘤分期及CT影像學表現(xiàn)T4T4:Atumorofanysizethatinvadesanyofthefollowing:mediastinum,heart,greatvessels,trachea,esophagus,vertebralbody,carina;oranytumorwithamalignantpleuralorpericardialeffusion;orwithsatellitetumornoduleswithintheipsilateralprimary-tumorlobeofthelung.

肺癌的腫瘤分期及CT影像學表現(xiàn)T4Example1:Thispatientwithbronchogeniccarcinomahadalargecentralmassthatwasdirectlyinvadingthesuperiorvenacava(yellowarrows).LesionsthatinvadethegreatvesselsareconsideredT4:

肺癌的腫瘤分期及CT影像學表現(xiàn)T4Example2:ThisisanexampleofaT4lesioninapatientwithNSCLCthatwasinvadingathoracicvertebralbody.Theribisalsoinvolved.肺癌的腫瘤分期及CT影像學表現(xiàn)T4Example3:Thispatientwithadenocarcinomahadalargemasswhichwasobstructingtheleftupperlobebronchuscausingleftupperlobecollapse.ThelargeleftpleuraleffusionwaspositiveformalignantcellsmakingthisaT4lesion.Otherimportantfindingswhichindicatenon-resectabilityinthiscaseincludeencasementoftheleftpulmonaryarterytoit'soriginfromthemainpulmonaryartery.

肺癌的腫瘤分期及CT影像學表現(xiàn)T4Example4:Thispatientwithadenocarcinomaofthesuperiorsegmentoftheleftlowerlobe(yellowarrow)wasalsonotedtohaveastellitenoduleintheipsilateraltumorlobe(