Lung Cancer Staging: Clinical and Radiologic Perspectives

Published in 2009, the 7th edition of the American Joint Committee on Cancer TNM staging system is the culmination of an extensive worldwide initiative to standardize and validate lung cancer staging. Unlike prior editions, the new staging system is now inclusive of small cell carcinoma and carcinoid tumors. In addition, significant changes were made to the T and M descriptors, resulting in improved prognostic stratification of disease. This review article highlights these changes, the rationale for their inclusion in the new staging manual, and the role of the radiologist in determining stage.

[1]  J. Crowley,et al.  The IASLC Lung Cancer Staging Project: Proposals for the Revision of the TNM Stage Groupings in the Forthcoming (Seventh) Edition of the TNM Classification of Malignant Tumours , 2007, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[2]  Carol C Wu,et al.  Lung cancer staging essentials: the new TNM staging system and potential imaging pitfalls. , 2010, Radiographics : a review publication of the Radiological Society of North America, Inc.

[3]  J. Cataldo,et al.  Smoking Cessation: An Integral Part of Lung Cancer Treatment , 2010, Oncology.

[4]  J. Crowley,et al.  The IASLC Lung Cancer Staging Project: Data Elements for the Prospective Project , 2009, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[5]  N. Gupta,et al.  Comparative efficacy of positron emission tomography with fluorodeoxyglucose in evaluation of small (<1 cm), intermediate (1 to 3 cm), and large (>3 cm) lymph node lesions. , 2000, Chest.

[6]  Masumi Kadoya,et al.  High-Resolution CT Features: Prognostic Significance in Peripheral Lung Adenocarcinoma with Bronchioloalveolar Carcinoma Components , 2003, Respiration.

[7]  P. Goldstraw,et al.  Inter-observer variability in systematic nodal dissection: comparison of European and Japanese nodal designation. , 2002, The Annals of thoracic surgery.

[8]  Thomas Beyer,et al.  Non-small cell lung cancer: dual-modality PET/CT in preoperative staging. , 2003, Radiology.

[9]  C. Tu,et al.  Impact of the New Lung Cancer Staging System for a Predominantly Advanced-Disease Patient Population , 2010, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[10]  P Armstrong,et al.  Staging non-small cell lung cancer. , 1993, Clinical radiology.

[11]  T. Naruke,et al.  Lymph node mapping and curability at various levels of metastasis in resected lung cancer. , 1978, The Journal of thoracic and cardiovascular surgery.

[12]  The role of CT and MRI in staging of the mediastinum. , 1994, Chest.

[13]  C. Mountain,et al.  Revisions in the International System for Staging Lung Cancer. , 1997, Chest.

[14]  M. Tsuboi,et al.  Comparison of thin-section CT and pathological findings in small solid-density type pulmonary adenocarcinoma: prognostic factors from CT findings. , 2012, European journal of radiology.

[15]  K. Nagai,et al.  Prognostic significance of a solid component in pulmonary adenocarcinoma. , 2011, The Annals of thoracic surgery.

[16]  G. Pelosi The new taxonomy of lung adenocarcinoma stemming from a multidisciplinary integrated approach: novel pathology concepts and perspectives. , 2011, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[17]  J. Crowley,et al.  Should the 7th Edition of the Lung Cancer Stage Classification System Change Treatment Algorithms in Non-small Cell Lung Cancer? , 2010, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[18]  E H Moore,et al.  Bronchogenic carcinoma: analysis of staging in the mediastinum with CT by correlative lymph node mapping and sampling. , 1992, Radiology.

[19]  M. Chung,et al.  Nodal metastasis in non-small cell lung cancer: accuracy of 3.0-T MR imaging. , 2008, Radiology.

[20]  S. Thibodeau,et al.  Clinical features of 5,628 primary lung cancer patients: experience at Mayo Clinic from 1997 to 2003. , 2005, Chest.

[21]  M. L. R. D. Christenson,et al.  The IASLC Lung Cancer Staging Project: A Proposal for a New International Lymph Node Map in the Forthcoming Seventh Edition of the TNM Classification for Lung Cancer , 2010 .

[22]  G. V. von Schulthess,et al.  Non-small cell lung cancer: nodal staging with FDG PET versus CT with correlative lymph node mapping and sampling. , 1997, Radiology.

[23]  C. Compton,et al.  AJCC Cancer Staging Manual , 2002, Springer New York.

[24]  R. Loddenkemper,et al.  MRI and CT in the differential diagnosis of pleural disease. , 2000, Chest.

[25]  Calum MacAulay,et al.  Innovative molecular and imaging approaches for the detection of lung cancer and its precursor lesions , 2002, Oncogene.

[26]  L. Quint,et al.  Radiologic staging of lung cancer. , 1999, Journal of thoracic imaging.

[27]  Masahiro Tsuboi,et al.  Correlations of Thin-Section Computed Tomographic, Histopathological, and Clinical Findings of Adenocarcinoma With a Bubblelike Appearance , 2010, Journal of computer assisted tomography.

[28]  J. Zell,et al.  The Applicability of the Proposed IASLC Staging Revisions to Small Cell Lung Cancer (SCLC) with Comparison to the Current UICC 6th TNM Edition , 2009, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[29]  N. Gupta,et al.  Comparative efficacy of positron emission tomography with fluorodeoxyglucose in evaluation of small ( 3 cm) lymph node lesions. , 2000 .

[30]  H. Groen,et al.  Preoperative staging of non-small-cell lung cancer with positron-emission tomography. , 2000, The New England journal of medicine.

[31]  Douglas C McCrory,et al.  Noninvasive staging of non-small cell lung cancer: a review of the current evidence. , 2003, Chest.

[32]  S. Ou,et al.  Validation Study of the Proposed IASLC Staging Revisions of the T4 and M Non-small Cell Lung Cancer Descriptors Using Data from 23,583 Patients in the California Cancer Registry , 2008, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[33]  L. Tanoue,et al.  Subsolid Pulmonary Nodules and the Spectrum of Peripheral Adenocarcinomas of the Lung: Recommended Interim Guidelines for Assessment and Management , 2011 .

[34]  A. Daley,et al.  Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis , 2010, BMJ : British Medical Journal.

[35]  Vasilis Ntziachristos,et al.  Use of gene expression profiling to direct in vivo molecular imaging of lung cancer. , 2005, Proceedings of the National Academy of Sciences of the United States of America.

[36]  N. Muller,et al.  Malignant chest wall neoplasms of bone and cartilage: a pictorial review of CT and MR findings. , 2007, The British journal of radiology.

[37]  Carlo Bartolozzi,et al.  Response to radiofrequency ablation of pulmonary tumours: a prospective, intention-to-treat, multicentre clinical trial (the RAPTURE study). , 2008, The Lancet. Oncology.

[38]  T. Wentzel‐Larsen,et al.  A population-based evaluation of the seventh edition of the TNM system for lung cancer , 2010, European Respiratory Journal.

[39]  M. Brecht,et al.  Quality of life of long-term survivors of non-small-cell lung cancer. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[40]  Cai-cun Zhou,et al.  The International Association for the Study of Lung Cancer Staging Project: Proposals Regarding the Clinical Staging of Small Cell Lung Cancer in the Forthcoming (Seventh) Edition of the Tumor,Node,Metastasis Classification for Lung Cancer , 2008 .

[41]  A. Adjei,et al.  Small cell lung cancer. , 2008, Mayo Clinic proceedings.

[42]  P. Yildiz,et al.  Comparison of clinical and surgical-pathologic staging of the patients with non-small cell lung carcinoma. , 2002, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[43]  Hisao Asamura,et al.  The IASLC Lung Cancer Staging Project: A Proposal for a New International Lymph Node Map in the Forthcoming Seventh Edition of the TNM Classification for Lung Cancer , 2009, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[44]  C. Mountain,et al.  Regional lymph node classification for lung cancer staging. , 1997, Chest.

[45]  J. Crowley,et al.  The IASLC Lung Cancer Staging Project: Validation of the Proposals for Revision of the T, N, and M Descriptors and Consequent Stage Groupings in the Forthcoming (Seventh) Edition of the TNM Classification of Malignant Tumours , 2007, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[46]  J. Crowley,et al.  The International Association for the Study of Lung Cancer International Staging Project on Lung Cancer , 2006 .

[47]  C. Mountain,et al.  A system for the clinical staging of lung cancer. , 1974, The American journal of roentgenology, radium therapy, and nuclear medicine.

[48]  Michael K Gould,et al.  Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition). , 2007, Chest.

[49]  C. Mountain The new International Staging System for Lung Cancer. , 1986, The Surgical clinics of North America.

[50]  Steven E Schild,et al.  Non-small cell lung cancer: epidemiology, risk factors, treatment, and survivorship. , 2008, Mayo Clinic proceedings.

[51]  L. Sobin,et al.  TNM Classification of Malignant Tumours , 1987, UICC International Union Against Cancer.

[52]  Charles A Powell,et al.  International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society: international multidisciplinary classification of lung adenocarcinoma: executive summary. , 2011, Proceedings of the American Thoracic Society.

[53]  P. Valk,et al.  Factors associated with false-positive staging of lung cancer by positron emission tomography. , 2000, The Annals of thoracic surgery.

[54]  Denise R. Aberle,et al.  Radiologic implications of the 2011 classification of adenocarcinoma of the lung. , 2013, Radiology.

[55]  Elisabeth Brambilla,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 , 2007, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[56]  Renato Martins,et al.  Small cell lung cancer. , 2008, Journal of the National Comprehensive Cancer Network : JNCCN.

[57]  G. V. von Schulthess,et al.  Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. , 2003, The New England journal of medicine.

[58]  M. L. R. D. Christenson,et al.  International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Classification of Lung Adenocarcinoma , 2012 .

[59]  R. Levitt,et al.  Pleural and chest wall invasion in bronchogenic carcinoma: CT evaluation. , 1985, Radiology.

[60]  L. Schwartz,et al.  Correlation between tumor measurement on Computed Tomography and resected specimen size in lung adenocarcinomas. , 2012, Lung cancer.

[61]  Kari Chansky,et al.  The IASLC Lung Cancer Staging Project: Proposals Regarding the Relevance of TNM in the Pathologic Staging of Small Cell Lung Cancer in the Forthcoming (Seventh) Edition of the TNM Classification for Lung Cancer , 2009, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[62]  Y. Sakao,et al.  Subtypes of peripheral adenocarcinoma of the lung: differentiation by thin-section CT , 2005, European Radiology.

[63]  A. Daley,et al.  INFLUENCE OF SMOKING CESSATION ON PROGNOSIS IN EARLY STAGE LUNG CANCER: A SYSTEMATIC REVIEW WITH META ANALYSIS , 2010 .

[64]  K. Fong,et al.  The science behind the 7th edition Tumour, Node, Metastasis staging system for lung cancer , 2012, Respirology.

[65]  P. Molina,et al.  Indeterminate mediastinal invasion in bronchogenic carcinoma: CT evaluation. , 1989, Radiology.

[66]  J. Crowley,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 , 2007, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[67]  V. Rusch,et al.  Visceral Pleural Invasion: Pathologic Criteria and Use of Elastic Stains: Proposal for the 7th Edition of the TNM Classification for Lung Cancer , 2008, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[68]  L. Sobin,et al.  The process for continuous improvement of the TNM classification , 2004, Cancer.

[69]  J. Crowley,et al.  The IASLC Lung Cancer Staging Project: Proposals for the Revision of the N Descriptors in the Forthcoming Seventh Edition of the TNM Classification for Lung Cancer , 2007, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[70]  J. Crowley,et al.  The IASLC Lung Cancer Staging Project: Proposals for the Inclusion of Broncho-Pulmonary Carcinoid Tumors in the Forthcoming (Seventh) Edition of the TNM Classification for Lung Cancer , 2008, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[71]  B J McNeil,et al.  CT and MR imaging in staging non-small cell bronchogenic carcinoma: report of the Radiologic Diagnostic Oncology Group. , 1991, Radiology.