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{{Lung mass}}
{{Lung mass}}
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==Overview==
==Overview==
Lung [[biopsy]] is the gold standard test for diagnosis of lung mass. However, in order to determine the extent of lung mass and to derive therapy other tests such as [[CT scan]], sputum cytology and [[PET scan|PET]] scan are also necessary. According to the [[American Joint Committee on Cancer|American Joint Committee on Cancer (AJCC)]] staging system, there are 4 stages of malignant lung mass, based on 3 factors: tumor size, lymph node invasion, and metastasis. Each stage is assigned a letter and a number  that designate T for tumor size, N for node invasion, and M for metastasis.


==Diagnostic Study of Choice==
==Diagnostic Study of Choice==
Lung biopsy is the gold standard test for the diagnosis of lung mass. However, in order to determine the extent of lung mass and to derive therapy other tests are also necessary.
 
*A multidisciplinary approach is required to correctly identify the sub-type of lung mass and its staging.
=== Study of Choice ===
*In general, diagnosis of lung mass is supplemented by the presence of clinical, radiological and pathological evidence.
Lung [[biopsy]] is the gold standard test for the diagnosis of lung mass. However, in order to determine the extent of lung mass and to derive therapy other tests are also necessary.<ref>Kasper, Dennis L., et al. Harrison's principles of internal medicine. New York: McGraw Hill Education, 2015. Print</ref><ref name="pmid22391408">{{cite journal |vauthors=Frank L, Quint LE |title=Chest CT incidentalomas: thyroid lesions, enlarged mediastinal lymph nodes, and lung nodules |journal=Cancer Imaging |volume=12 |issue= |pages=41–8 |date=March 2012 |pmid=22391408 |pmc=3335330 |doi=10.1102/1470-7330.2012.0006 |url=}}</ref><ref name="pmid17225705">{{cite journal |vauthors=Collins LG, Haines C, Perkel R, Enck RE |title=Lung cancer: diagnosis and management |journal=Am Fam Physician |volume=75 |issue=1 |pages=56–63 |date=January 2007 |pmid=17225705 |doi= |url=}}</ref>
*Mode of biopsy also depends upon the age and condition of patient. These include:
*A multidisciplinary approach is required to correctly identify the sub-type of lung mass and its [[Cancer staging|staging]].
*In general, diagnosis of lung mass is supplemented by the presence of [[clinical]], [[radiological]] and [[pathological]] evidence.
*Mode of [[biopsy]] also depends upon the age and condition of patient. These include:
**Ultrasound guided bronchial washings/brushings and aspiration.
**Ultrasound guided bronchial washings/brushings and aspiration.
**Bronchoscopy or CT-guided biopsy.
**[[Bronchoscopy]] or [[CT]]-guided biopsy.
**Unreachable lesions are evaluated with video-assisted thoracoscopic surgery.
**Unreachable lesions are evaluated with video-assisted thoracoscopic surgery.
**Frozen sections in case of patients already undergoing surgery for a secondary condition.
**Frozen sections in case of patients already undergoing surgery for a secondary condition.
 
{{Lung mass}}
===Staging===
The following table depicts the TNM classification for lung cancer:
{| class="wikitable" style="text-align:center;font-size:90%;margin-left:1em;background:#E5AFAA;"
|+TNM classification of lung cancer <ref name="Harrison">{{Cite journal | last=Chheang | first=S |author2=Brown K | title=Lung cancer staging: clinical and radiologic perspectives | journal=Seminars in Interventional Radiology | volume=30 | issue=2 | pages=99–113 |date=June 2013 | pmid=24436525 | pmc=3709937 | doi=10.1055/s-0033-1342950}}</ref>
|-
|
{| class="wikitable"
|-
! colspan="3" |T: Primary tumor
|-
| rowspan="2" |TX
| rowspan="2" |Any of:
|Primary tumor cannot be assessed
|-
|Tumor cells present in sputum or bronchial washing, but tumor not seen with imaging or bronchoscopy
|-
|T0
| colspan="2" |No evidence of primary tumor
|-
|Tis
| colspan="2" |[[Carcinoma in situ]]
|-
|T1
| colspan="2" |Tumor size less than or equal to 3&nbsp;cm across, surrounded by lung or visceral pleura, without invasion proximal to the lobar bronchus
|-
|T1a
| colspan="2" |Tumor size less than or equal to 2&nbsp;cm across
|-
|T1b
| colspan="2" |Tumor size more than 2&nbsp;cm but less than or equal to 3&nbsp;cm across
|-
| rowspan="4" |T2
| rowspan="4" |Any of:
|Tumor size more than 3&nbsp;cm but less than or equal to 7&nbsp;cm across
|-
|Involvement of the main bronchus at least 2&nbsp;cm distal to the carina
|-
|Invasion of visceral pleura
|-
|Atelectasis/obstructive pneumonitis extending to the hilum but not involving the whole lung
|-
|T2a
| colspan="2" |Tumor size more than 3&nbsp;cm but less than or equal to 5&nbsp;cm across
|-
|T2b
| colspan="2" |Tumor size more than 5&nbsp;cm but less than or equal to 7&nbsp;cm across
|-
| rowspan="5" |T3
| rowspan="5" |Any of:
|Tumor size more than 7&nbsp;cm across
|-
|Invasion into the chest wall, diaphragm, [[phrenic nerve]], mediastinal pleura or parietal [[pericardium]]
|-
|Tumor less than 2&nbsp;cm distal to the carina, but not involving the carina
|-
|Atelectasis/obstructive pneumonitis of the whole lung
|-
|Separate tumor nodule in the same lobe
|-
| rowspan="2" |T4
| rowspan="2" |Any of:
|Invasion of the mediastinum, heart, great vessels, trachea, carina, recurrent laryngeal nerve, esophagus, or vertebra
|-
|Separate tumor nodule in a different lobe of the same lung
|}
| style="vertical-align:top;" |
{| class="wikitable"
|-
! colspan="3" |N: Lymph nodes
|-
|NX
| colspan="2" |Regional lymph nodes cannot be assessed
|-
|N0
| colspan="2" |No regional lymph node metastasis
|-
|N1
| colspan="2" |Metastasis to ipsilateral peribronchial and/or hilar lymph nodes
|-
|N2
| colspan="2" |Metastasis to ipsilateral mediastinal and/or subcarinal lymph nodes
|-
| rowspan="2" |N3
| rowspan="2" |Any of:
|Metastasis to scalene or supraclavicular lymph nodes
|-
|Metastasis to contralateral hilar or mediastinal lymph nodes
|}
| style="vertical-align:top;" |
{| class="wikitable"
|-
! colspan="3" |M: Metastasis
|-
|MX
| colspan="2" |Distant metastasis cannot be assessed
|-
|M0
| colspan="2" |No distant metastasis
|-
| rowspan="3" |M1a
| rowspan="3" |Any of:
|Separate tumor nodule in the other lung
|-
|Tumor with pleural nodules
|-
|Malignant pleural or pericardial effusion
|-
|M1b
| colspan="2" |Distant metastasis
|}
|}
==References==
{{reflist|2}}
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 20:32, 18 June 2019

Lung Mass Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Causes

Differentiating Lung Mass from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Diagnosis

Diagnostic Study of Choice

Evaluation of Lung Mass

Imaging of Lung Mass

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Lung mass diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Lung mass diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Lung mass diagnosis

CDC on Lung mass diagnosis

Lung mass diagnosis in the news

Blogs on Lung mass diagnosis

Directions to Hospitals Treating bone or soft tissue mass

Risk calculators and risk factors for Lung mass diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]

Overview

Lung biopsy is the gold standard test for diagnosis of lung mass. However, in order to determine the extent of lung mass and to derive therapy other tests such as CT scan, sputum cytology and PET scan are also necessary. According to the American Joint Committee on Cancer (AJCC) staging system, there are 4 stages of malignant lung mass, based on 3 factors: tumor size, lymph node invasion, and metastasis. Each stage is assigned a letter and a number that designate T for tumor size, N for node invasion, and M for metastasis.

Diagnostic Study of Choice

Study of Choice

Lung biopsy is the gold standard test for the diagnosis of lung mass. However, in order to determine the extent of lung mass and to derive therapy other tests are also necessary.[1][2][3]

  • A multidisciplinary approach is required to correctly identify the sub-type of lung mass and its staging.
  • In general, diagnosis of lung mass is supplemented by the presence of clinical, radiological and pathological evidence.
  • Mode of biopsy also depends upon the age and condition of patient. These include:
    • Ultrasound guided bronchial washings/brushings and aspiration.
    • Bronchoscopy or CT-guided biopsy.
    • Unreachable lesions are evaluated with video-assisted thoracoscopic surgery.
    • Frozen sections in case of patients already undergoing surgery for a secondary condition.

Lung Mass Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Causes

Differentiating Lung Mass from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Diagnosis

Diagnostic Study of Choice

Evaluation of Lung Mass

Imaging of Lung Mass

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Lung mass diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Lung mass diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Lung mass diagnosis

CDC on Lung mass diagnosis

Lung mass diagnosis in the news

Blogs on Lung mass diagnosis

Directions to Hospitals Treating bone or soft tissue mass

Risk calculators and risk factors for Lung mass diagnosis

Staging

The following table depicts the TNM classification for lung cancer:

TNM classification of lung cancer [4]
T: Primary tumor
TX Any of: Primary tumor cannot be assessed
Tumor cells present in sputum or bronchial washing, but tumor not seen with imaging or bronchoscopy
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor size less than or equal to 3 cm across, surrounded by lung or visceral pleura, without invasion proximal to the lobar bronchus
T1a Tumor size less than or equal to 2 cm across
T1b Tumor size more than 2 cm but less than or equal to 3 cm across
T2 Any of: Tumor size more than 3 cm but less than or equal to 7 cm across
Involvement of the main bronchus at least 2 cm distal to the carina
Invasion of visceral pleura
Atelectasis/obstructive pneumonitis extending to the hilum but not involving the whole lung
T2a Tumor size more than 3 cm but less than or equal to 5 cm across
T2b Tumor size more than 5 cm but less than or equal to 7 cm across
T3 Any of: Tumor size more than 7 cm across
Invasion into the chest wall, diaphragm, phrenic nerve, mediastinal pleura or parietal pericardium
Tumor less than 2 cm distal to the carina, but not involving the carina
Atelectasis/obstructive pneumonitis of the whole lung
Separate tumor nodule in the same lobe
T4 Any of: Invasion of the mediastinum, heart, great vessels, trachea, carina, recurrent laryngeal nerve, esophagus, or vertebra
Separate tumor nodule in a different lobe of the same lung
N: Lymph nodes
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis to ipsilateral peribronchial and/or hilar lymph nodes
N2 Metastasis to ipsilateral mediastinal and/or subcarinal lymph nodes
N3 Any of: Metastasis to scalene or supraclavicular lymph nodes
Metastasis to contralateral hilar or mediastinal lymph nodes
M: Metastasis
MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1a Any of: Separate tumor nodule in the other lung
Tumor with pleural nodules
Malignant pleural or pericardial effusion
M1b Distant metastasis

References

  1. Kasper, Dennis L., et al. Harrison's principles of internal medicine. New York: McGraw Hill Education, 2015. Print
  2. Frank L, Quint LE (March 2012). "Chest CT incidentalomas: thyroid lesions, enlarged mediastinal lymph nodes, and lung nodules". Cancer Imaging. 12: 41–8. doi:10.1102/1470-7330.2012.0006. PMC 3335330. PMID 22391408.
  3. Collins LG, Haines C, Perkel R, Enck RE (January 2007). "Lung cancer: diagnosis and management". Am Fam Physician. 75 (1): 56–63. PMID 17225705.
  4. Chheang, S; Brown K (June 2013). "Lung cancer staging: clinical and radiologic perspectives". Seminars in Interventional Radiology. 30 (2): 99–113. doi:10.1055/s-0033-1342950. PMC 3709937. PMID 24436525.

References