Lung cancer diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]Kim-Son H. Nguyen M.D., Cafer Zorkun, M.D., Ph.D. [3]. Rim Halaby, M.D. [4], Michael Maddaleni, B.S., Anum Ijaz M.B.B.S., M.D.[5]

Overview

Chest CT scan is the modality of choice in the diagnosis of lung cancer. Findings on CT scan suggestive of lung cancer include a solitary pulmonary nodule, centrally located masses, mediastinal invasion CT scans help stage the lung cancer. A CT scan of the abdomen and brain can help visualize the common sights of metastases such as adrenal glands, liver, and brain. CT scans diagnose lung cancer by providing anatomical detail to locate the tumor, demonstrating proximity to the nearby structures, and deciphering whether lymph nodes are enlarged in the mediastinum.

Diagnostic Study of Choice

Study of Choice

Chest CT scan is the modality of choice in the diagnosis of lung cancer. Findings on CT scan suggestive of lung cancer include:^[1]

Solitary pulmonary nodule
Centrally located masses
Mediastinal invasion
Peripherally situated lesions invading the chest wall
A ground-glass opacity
Consolidation
Mixed density or pure ground glass nodules
Mixed density or pure ground glass consolidation

Common radiological appearances of lung cancer. Centrally located mass with mediastinal invasion (arrow, A), peripherally situated mass abutting the pleura (arrow, B), mass with smooth, lobulated margins (arrow, C) and with spiculated, irregular margins (arrow, D), via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F1/>^[1]	Lung cancers with atypical radiological pattern. Squamous cell cancer presenting as a cavitating mass (arrow, A). Adenocarcinoma presenting as dense consolidation (arrow, B). Bronchoalveolar carcinoma (adenocarcinoma in situ) presenting as ground-glass opacity (arrow, C) and mixed density, solid (arrow), and ground-glass nodules (arrowhead) in D via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F2/>^[1]
Stage T1 and T2 tumors. Stage T1 tumor due to size < 3 cm (arrow, A). Stage T2 endobronchial tumor (arrowhead) causing pneumonitis restricted to the upper lobe (arrow) in B. T2a tumor > 3 cm but < 5 cm (arrow, C). T2b tumor > 5 cm but < 7 cm (arrow in D) via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F3/>^[1]	Stage T3 tumors. T3 tumor due to size > 7 cm in size (arrow, A), eroding the ribs (arrow, B), infiltrating the mediastinal pleura but not the vessels (arrow, C), and causing atelectasis of the entire lung (arrowhead, D via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F4/>.^[1]
Stage T4 tumors. T4 tumor due to invasion of pulmonary artery (arrow, A), descending aorta (arrow, B), vertebral body (arrow, C), superior vena cava with thrombus (arrow, D)via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F5/>^[1]	Superior sulcus tumor. Axial (A) and coronal (B) CT scans show a large mass in the apex of the right lung causing destruction of the first and second ribs (arrows) with erosion of the right half of the vertebral body (arrowheads) suggestive of a superior sulcus tumor, via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F16/>^[1]

Spiral CT Perfusion Imaging

Spiral CT perfusion study can be used as a diagnostic method for peripheral pulmonary nodules.
Spiral CT perfusion study provides non-invasive method for the quantitative assessment of blood flow patterns of peripheral pulmonary nodules.
Spiral CT perfusion imaging is analyzed and evaluated for:^[2]
- TDC (time density curve)
- Perfusion parametric maps
- The respective perfusion parameters
- Immunohistochemical findings of microvessel density (MVD) measurement
- VEGF expression

(A-H) Poorly differentiated adenocarcinoma found in the apicoposterior segment of superior lobe of the left lung of a 56 year-old male. (A) Time density curve. (B-F) (original image, BF, BV, MTT, PS) typeI parametric maps, PS value is higher (30.883). (G) CD34 staining shows many immature tumor microvessels (× 200). (H) VEGF expression is strong positive (× 400) via, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2474637/figure/F6/.^[2]	(A-H) (A-H) Well differentiated squamous cell carcinoma found in the posterior basal segment of inferior lobe of the right lung of a 61-year-old male. (A) Time density curve. (B-F) (original image, BF, BV, MTT, PS) TypeII parametric maps, PS value is higher (27.051). (G) CD34 staining shows many immature tumor microvessels (× 200). (H) VEGF expression is strong positive (× 400). via, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2474637/figure/F3/.^[2]

CT Findings of Metastatic disease

CT scans help stage the lung cancer. A CT scan of the abdomen and brain can help visualize the common sights of metastases such as adrenal glands, liver, and brain.
The benefits of CT scan in lung cancer patients are the following:^[3]
- Provides anatomical detail to locate the tumor
- Demonstrates proximity to nearby structures
- Deciphers whether lymph nodes are enlarged in the mediastinum

Metastatic disease. Bilateral pleural effusions-M1a (arrow, A), lung metastases-M1a (arrows, B), adrenal metastasis-M1b (arrow, C), vertebral metastasis-M1b (arrow, D), brain metastasis-M1b (arrow, E), liver metastases-M1b (arrows, F)via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F10/>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.^[1]	Adrenal adenoma versus metastasis. Enhancing solid adrenal nodule on CT scan in a case of lung cancer (arrow, A) suggestive of metastatic deposit. Unenhanced CT scan shows fatty attenuation within the nodule with an HU value of 0 suggesting the possibility of an adenoma (arrow, B). FDG-PET/CT shows no tracer concentration in the nodule, confirming the diagnosis of adenoma. Enhancing solid adrenal nodule on CT scan in another patient of lung cancer (arrow, D), which is indeterminate in nature. FDG-PET/CT shows abnormal focal tracer concentration in the nodule (arrow, E) highly suggestive of a metastatic deposit via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F11/>^[1]	Brain metastases in asymptomatic patient, CT scan versus MRI. MRI brain in a patient of lung cancer shows multiple tiny enhancing foci scattered in the parenchyma bilaterally (arrows in A and B) suggestive of metastatic lesions. Corresponding contrast CT scan sections of the brain show no obvious lesions (C and D). Note the beam hardening effects due to bone, leading to a loss of resolution on the CT images (C and D)via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F12/>^[1]

Unfortunately, research has shown that there are a number of false positives associated with CT scanning because CT scan alone cannot determine malignancy.
A positive result for a tumor using CT scan is typically followed up with a biopsy for confirmation.

Staging

The following is 2017 TNM classification of lung cancer.^[4]^[5]^[6]

T: Primary Tumor

T	Description
TX	Primary tumor cannot be assessed. OR Tumor is demonstrated by the presence of malignant cells in bronchial washings or sputum, but is not visualized by imaging or bronchoscopy.
T0	There is no evidence of primary tumor.
Tis	Carcinoma in situ
T1	The tumor has the following characteristics: T1a: Tumor ≤ 1 cm in the largest diameter. T1b: Tumor > 1 cm, but ≤ 2 cm in the largest diameter. T1c: Tumor > 2 cm, but ≤ 3 cm in the largest diameter. AND The tumor is surrounded by lung or visceral pleura AND The tumor does not extend to the main bronchus as demonstrated by the absence of bronchoscopic evidence of invasion more proximal than the lobar bronchus.
T2	The tumor has the following characteristics: T2a: Tumor > 3 cm, but ≤ 4 cm in the largest diameter. T2b: Tumor > 4 cm, but ≤ 5 cm in the largest diameter. The tumor involves the main bronchus, 2 cm or more distal to the carina. OR The tumor invades the visceral pleura. OR There is evidence of atelectasis or obstructive pneumonitis that extends to the hilar region without the involvement of the entire lung.
T3	Tumor > 5 cm, but ≤ 7 cm in size. AND It directly invades any of the following: Chest wall (including superior sulcus tumors), diaphragm, mediastinal pleura, parietal pericardium. OR The tumor is localized in the main bronchus at a distance less than 2 cm distal to the carina but without the involvement of the carina. OR There is evidence of associated atelectasis or obstructive pneumonitis of the entire lung.
T4	Tumor > 7 cm in size. The tumor invades any of the following: Mediastinum, heart, great vessels, trachea, esophagus, vertebral body, and carina OR There is/are separate tumor nodule(s) in the same lobe. OR The tumor is associated with malignant pleural effusion.

N: Regional Lymph Nodes

T	Description
NX	Regional lymph nodes cannot be assessed.
N0	There is no evidence of regional lymph node metastasis.
N1	Metastasis in ipsilateral peribronchial and/or ipsilateral hilum or intrapulmonary lymph nodes N1a: Invasion of 1 lymph node. N1b: > 1 lymph node affected.
N2	There is metastasis in the ipsilateral mediastinal and/or subcarinal lymph node(s). N2a1: One lymph node affected without lymph node involvement of an N1-defined lymph node station. N2a2: One lymph node affected with a lymph node of an N1-defined lymph node station N2b: > 1 lymph node affected
N3	There is metastasis in the contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s).

M: Distant Metastasis

T	Description
MX	Distant metastasis cannot be assessed.
M0	There is no evidence of distant metastasis.
M1	There is evidence of distant metastasis which includes the presence of separate tumor nodule(s) in a different lobe (ipsilateral or contralateral). M1a: Tumor foci separated from the primary tumor in a contralateral lung lobe; tumor with pleural metastases or malignant pleural or pericardial effusion M1b: Single metastatic lesion in an organ M1c: Multiple metastases in one organ or one or more metastases in more than one organ

Classification of Lung Cancer by Staging

Stage	T	N	M
Occult carcinoma	TX	N0	M0
Stage 0	Tis	N0	M0
Stage IA1	T1(mi)/T1a	N0	M0
Stage IA2	T1b	N0	M0
Stage IA3	T1c	N0	M0
Stage IB	T2a	N0	M0
Stage IIA	T2b	N0	M0
Stage IIB	T1a	N1	M0
	T1c	N1	M0
	T2a	N1	M0
	T2b	N1	M0
	T3	N0	M0
Stage IIIA	T1a	N2	M0
	T1b	N2	M0
	T1c	N2	M0
	T2a	N2	M0
	T2b	N2	M0
	T1a	N2	M0
	T1b	N2	M0
	T1c	N2	M0
	T2a	N2	M0
	T2b	N2	M0
	T3	N1	M0
	T4	N0	M0
	T4	N1	M0
Stage IIIB	T1a	N3	M0
	T1b	N3	M0
	T1c	N3	M0
	T2a	N3	M0
	T2b	N3	M0
	T1a	N3	M0
	T1b	N3	M0
	T1c	N3	M0
	T2a	N3	M0
	T2b	N3	M0
	T3	N2	M0
	T4	N2	M0
Stage IIIC	T3	N3	M0
Stage IIIC	T4	N3	M0
Stage IVA	Any T	Any N	M1a
Stage IVA	Any T	Any N	M1b
Stage IVB	Any T	Any N	M1c

Procedures for Staging Lung Cancer

There are currently multiple different procedures available to stage lung cancer.

They can be broken down into two overarching categories, invasive and minimally invasive.

Invasive

Minimally Invasive

EBUS-FNA (endobronchial ultrasound guided fine needle aspiration)
EUS-FNA (esophageal endoscopic ultrasound guided fine needle aspiration)

Diagnostic Sequence in Lung Cancer

Initial Imaging Evaluation

In patients with chest symptoms concerning for lung cancer or an abnormal chest radiograph, contrast-enhanced chest CT is recommended to evaluate the primary lesion and assess nodal involvement or distant metastases.^[7]
Brain imaging, preferably with MRI, should be performed in all patients diagnosed with lung cancer.^[8]
Fluorodeoxyglucose positron emission tomography-CT (FDG PET-CT) is recommended for patients being considered for potentially curative local therapy (surgery or radiotherapy) to evaluate mediastinal lymph nodes and exclude metastatic disease.^[9]
Indeterminate pulmonary nodules should be managed according to Fleischner Society guidelines; more than 95% are benign, and the probability of malignancy is <1% for nodules <6 mm.^[10]

Moderately differentiated adenocarcinoma (SUVmax 6.9) of the upper lobe of the left lung with benign bilateral mediastinal nodes: SUVmax 4.5 (SUVmax liver 3) and pleural effusion; even if the SUV value of nodes is higher than the liver uptake, the pattern of symmetric FDG uptake helps to suspect inflammatory condition. In patients with an imaging finding suggestive of metastasis, further evaluation of the abnormality with tissue sampling to pathologically confirm the clinical stage is recommended prior to choosing treatment.via https://pmc.ncbi.nlm.nih.gov/articles/PMC8206197/figure/F1/^[11]	Moderately differentiated adenocarcinoma G2 (70% Acinar, 20% Lepidic, 10% Papillary) of the upper lobe of the right lung (SUVmax 3.5). Surgery identified hilar node metastasis (SUVmax 2.0; SUVmax liver 2.5) not identified by FDG PET/CT Imaging. It should be kept in mind that in patients with less avid primary tumors, node metastases may be missed by FDG PET/CT imaging.via https://pmc.ncbi.nlm.nih.gov/articles/PMC8206197/figure/F2/^[11]	Small node metastasis (SUVmax 2.0; SUVmax liver 2.5) in patient with poorly differentiated adenocarcinoma with large cells of the left lung (G3). Nodes are likely to have metabolically similar cells within them to the primary lesion, and consequently, a small intensely avid node, even with an SUV value lower than liver SUV value, is more likely to be malignant. In patients with PET activity in a mediastinal lymph node and normal-appearing nodes by CT (and no distant metastases), an invasive staging of the mediastinum is recommended over staging by imaging alone.via https://pmc.ncbi.nlm.nih.gov/articles/PMC8206197/figure/F3/^[11]	Enlarged paratracheal metastasis (4R; SUVmax 1.5; SUVmax liver 2.4) in patient with squamous cell carcinoma of the right lung. FDG PET/CT resulted to be negative with SUV value lower than the liver SUV value. Invasive mediastinal staging should be carried out in central tumors and solid T2 tumors even if the FDG PET/CT scan does not suggest mediastinal node involvement because the risk of occult nodal involvement is relatively high.via https://pmc.ncbi.nlm.nih.gov/articles/PMC8206197/figure/F4/^[11]

Tissue Diagnosis and Staging

Definitive diagnosis is established by biopsy of tumor tissue from the lung and/or lymph nodes using percutaneous or bronchoscopic techniques, often guided by endobronchial ultrasound, which also aids in staging.^[7]

Molecular Profiling

Comprehensive molecular testing should be performed for all nonsmoking individuals with lung cancer to guide targeted therapy and immunotherapy decisions.^[12]
Next-generation sequencing using DNA and RNA panels is recommended to identify actionable variants and gene rearrangements, including EGFR, ALK, ROS1, and RET.^[12]

Liquid Biopsy and Disease Monitoring

Liquid biopsy using circulating tumor DNA (ctDNA) is an emerging diagnostic approach, particularly when tumor tissue is limited.^[13]
Preoperative ctDNA status has prognostic significance, with improved 5-year overall survival reported in ctDNA-negative compared with ctDNA-high patients.
At disease progression or treatment resistance, repeat tissue biopsy or liquid biopsy may identify resistance mechanisms, such as alterations in the PI3K/AKT/mTOR pathway or RAS, to inform subsequent therapeutic strategies.^[14]

References

↑ ^1.00 ^1.01 ^1.02 ^1.03 ^1.04 ^1.05 ^1.06 ^1.07 ^1.08 ^1.09 Purandare, NilenduC; Rangarajan, Venkatesh (2015). "Imaging of lung cancer: Implications on staging and management". Indian Journal of Radiology and Imaging. 25 (2): 109. doi:10.4103/0971-3026.155831. ISSN 0971-3026.
↑ ^2.0 ^2.1 ^2.2 Ma, Shu-Hua; Le, Hong-Bo; Jia, Bao-hui; Wang, Zhao-Xin; Xiao, Zhuang-Wei; Cheng, Xiao-Ling; Mei, Wei; Wu, Min; Hu, Zhi-Guo; Li, Yu-Guang (2008). "Peripheral pulmonary nodules: Relationship between multi-slice spiral CT perfusion imaging and tumor angiogenesis and VEGF expression". BMC Cancer. 8 (1). doi:10.1186/1471-2407-8-186. ISSN 1471-2407.
↑ Gerard A. Silvestri, Lynn T. Tanoue, Mitchell L. Margolis, John Barker, Frank Detterbeck.11/30/11.The Noninvasive Staging of Non Small-cell Lung Cancer. Chestpubs. http://chestjournal.chestpubs.org/content/123/1_suppl/147S.full/
↑ Mountain, CF (2003). A Handbook for Staging, Imaging, and Lymph Node Classification. Charles P Young Company. Retrieved 2007-09-01. Unknown parameter |coauthors= ignored (help)
↑ Collins, LG (Jan 2007). "Lung cancer: diagnosis and management". American Family Physician. American Academy of Family Physicians. 75 (1): 56–63. PMID 17225705. Retrieved 2007-08-10. Unknown parameter |coauthors= ignored (help)
↑ Harms, A.; Kriegsmann, M.; Fink, L.; Länger, F.; Warth, A. (2017). "Die neue TNM-Klassifikation für Lungentumoren". Der Pathologe. 38 (1): 11–20. doi:10.1007/s00292-017-0268-y. ISSN 0172-8113.
↑ ^7.0 ^7.1 Murphy C, Pandya T, Swanton C, Solomon BJ (November 2025). "Lung Cancer in Nonsmoking Individuals: A Review". JAMA. 334 (20): 1836–1845. doi:10.1001/jama.2025.17695. PMC 7618360 Check |pmc= value (help). PMID 41114991 Check |pmid= value (help).
↑ Rangachari D, Yamaguchi N, VanderLaan PA, Folch E, Mahadevan A, Floyd SR, Uhlmann EJ, Wong ET, Dahlberg SE, Huberman MS, Costa DB (April 2015). "Brain metastases in patients with EGFR-mutated or ALK-rearranged non-small-cell lung cancers". Lung Cancer. 88 (1): 108–11. doi:10.1016/j.lungcan.2015.01.020. PMC 4355240. PMID 25682925.
↑ Riba MB, Donovan KA, Ahmed K, Andersen B, Braun I, Breitbart WS, Brewer BW, Corbett C, Fann J, Fleishman S, Garcia S, Greenberg DB, Handzo GF, Hoofring LH, Huang CH, Hutchinson S, Johns S, Keller J, Kumar P, Lahijani S, Martin S, Niazi SK, Pailler M, Parnes F, Rao V, Salman J, Scher E, Schuster J, Teply M, Usher A, Valentine AD, Vanderlan J, Lyons MS, McMillian NR, Darlow SD (May 2023). "NCCN Guidelines® Insights: Distress Management, Version 2.2023". J Natl Compr Canc Netw. 21 (5): 450–457. doi:10.6004/jnccn.2023.0026. PMID 37156476 Check |pmid= value (help).
↑ [+https://jamanetwork.com/journals/jama/article-abstract/2788136 "Validate User"] Check |url= value (help).
↑ ^11.0 ^11.1 ^11.2 ^11.3 Farsad M (2020). "FDG PET/CT in the Staging of Lung Cancer". Curr Radiopharm. 13 (3): 195–203. doi:10.2174/1874471013666191223153755. PMC 8206197 Check |pmc= value (help). PMID 31868151.
↑ ^12.0 ^12.1 Riely GJ, Wood DE, Ettinger DS, Aisner DL, Akerley W, Bauman JR, Bharat A, Bruno DS, Chang JY, Chirieac LR, DeCamp M, Desai AP, Dilling TJ, Dowell J, Durm GA, Gettinger S, Grotz TE, Gubens MA, Juloori A, Lackner RP, Lanuti M, Lin J, Loo BW, Lovly CM, Maldonado F, Massarelli E, Morgensztern D, Mullikin TC, Ng T, Owen D, Owen DH, Patel SP, Patil T, Polanco PM, Riess J, Shapiro TA, Singh AP, Stevenson J, Tam A, Tanvetyanon T, Yanagawa J, Yang SC, Yau E, Gregory KM, Hang L (May 2024). "Non-Small Cell Lung Cancer, Version 4.2024, NCCN Clinical Practice Guidelines in Oncology". J Natl Compr Canc Netw. 22 (4): 249–274. doi:10.6004/jnccn.2204.0023. PMID 38754467 Check |pmid= value (help).
↑ Black JR, Bartha G, Abbott CW, Boyle SM, Karasaki T, Li B, Chen R, Harris J, Veeriah S, Colopi M, Bakir MA, Liu WK, Lyle J, Navarro FC, Northcott J, Pyke RM, Hill MS, Thol K, Huebner A, Bailey C, Colliver EC, Martínez-Ruiz C, Grigoriadis K, Pawlik P, Moore DA, Marinelli D, Shutkever OG, Murphy C, Sivakumar M, Shaw JA, Hackshaw A, McGranahan N, Jamal-Hanjani M, Frankell AM, Chen RO, Swanton C (January 2025). "Ultrasensitive ctDNA detection for preoperative disease stratification in early-stage lung adenocarcinoma". Nat Med. 31 (1): 70–76. doi:10.1038/s41591-024-03216-y. PMC 11750713 Check |pmc= value (help). PMID 39806071 Check |pmid= value (help).
↑ Jee J, Lebow ES, Yeh R, Das JP, Namakydoust A, Paik PK, Chaft JE, Jayakumaran G, Rose Brannon A, Benayed R, Zehir A, Donoghue M, Schultz N, Chakravarty D, Kundra R, Madupuri R, Murciano-Goroff YR, Tu HY, Xu CR, Martinez A, Wilhelm C, Galle J, Daly B, Yu HA, Offin M, Hellmann MD, Lito P, Arbour KC, Zauderer MG, Kris MG, Ng KK, Eng J, Preeshagul I, Victoria Lai W, Fiore JJ, Iqbal A, Molena D, Rocco G, Park BJ, Lim LP, Li M, Tong-Li C, De Silva M, Chan DL, Diakos CI, Itchins M, Clarke S, Pavlakis N, Lee A, Rekhtman N, Chang J, Travis WD, Riely GJ, Solit DB, Gonen M, Rusch VW, Rimner A, Gomez D, Drilon A, Scher HI, Shah SP, Berger MF, Arcila ME, Ladanyi M, Levine RL, Shen R, Razavi P, Reis-Filho JS, Jones DR, Rudin CM, Isbell JM, Li BT (November 2022). "Overall survival with circulating tumor DNA-guided therapy in advanced non-small-cell lung cancer". Nat Med. 28 (11): 2353–2363. doi:10.1038/s41591-022-02047-z. PMC 10338177 Check |pmc= value (help). PMID 36357680 Check |pmid= value (help).

Template:Tumors

Template:WikiDoc Sources

[PurandareRangarajan2015-1] 1.00 ^1.01 ^1.02 ^1.03 ^1.04 ^1.05 ^1.06 ^1.07 ^1.08 ^1.09 Purandare, NilenduC; Rangarajan, Venkatesh (2015). "Imaging of lung cancer: Implications on staging and management". Indian Journal of Radiology and Imaging. 25 (2): 109. doi:10.4103/0971-3026.155831. ISSN 0971-3026.

[MaLe2008-2] 2.0 ^2.1 ^2.2 Ma, Shu-Hua; Le, Hong-Bo; Jia, Bao-hui; Wang, Zhao-Xin; Xiao, Zhuang-Wei; Cheng, Xiao-Ling; Mei, Wei; Wu, Min; Hu, Zhi-Guo; Li, Yu-Guang (2008). "Peripheral pulmonary nodules: Relationship between multi-slice spiral CT perfusion imaging and tumor angiogenesis and VEGF expression". BMC Cancer. 8 (1). doi:10.1186/1471-2407-8-186. ISSN 1471-2407.

[Silvestri-3] Gerard A. Silvestri, Lynn T. Tanoue, Mitchell L. Margolis, John Barker, Frank Detterbeck.11/30/11.The Noninvasive Staging of Non Small-cell Lung Cancer. Chestpubs. http://chestjournal.chestpubs.org/content/123/1_suppl/147S.full/

[4] Mountain, CF (2003). A Handbook for Staging, Imaging, and Lymph Node Classification. Charles P Young Company. Retrieved 2007-09-01. Unknown parameter |coauthors= ignored (help)

[Collins-5] Collins, LG (Jan 2007). "Lung cancer: diagnosis and management". American Family Physician. American Academy of Family Physicians. 75 (1): 56–63. PMID 17225705. Retrieved 2007-08-10. Unknown parameter |coauthors= ignored (help)

[HarmsKriegsmann2017-6] Harms, A.; Kriegsmann, M.; Fink, L.; Länger, F.; Warth, A. (2017). "Die neue TNM-Klassifikation für Lungentumoren". Der Pathologe. 38 (1): 11–20. doi:10.1007/s00292-017-0268-y. ISSN 0172-8113.

[pmid41114991-7] 7.0 ^7.1 Murphy C, Pandya T, Swanton C, Solomon BJ (November 2025). "Lung Cancer in Nonsmoking Individuals: A Review". JAMA. 334 (20): 1836–1845. doi:10.1001/jama.2025.17695. PMC 7618360 Check |pmc= value (help). PMID 41114991 Check |pmid= value (help).

[pmid25682925-8] Rangachari D, Yamaguchi N, VanderLaan PA, Folch E, Mahadevan A, Floyd SR, Uhlmann EJ, Wong ET, Dahlberg SE, Huberman MS, Costa DB (April 2015). "Brain metastases in patients with EGFR-mutated or ALK-rearranged non-small-cell lung cancers". Lung Cancer. 88 (1): 108–11. doi:10.1016/j.lungcan.2015.01.020. PMC 4355240. PMID 25682925.

[pmid37156476-9] Riba MB, Donovan KA, Ahmed K, Andersen B, Braun I, Breitbart WS, Brewer BW, Corbett C, Fann J, Fleishman S, Garcia S, Greenberg DB, Handzo GF, Hoofring LH, Huang CH, Hutchinson S, Johns S, Keller J, Kumar P, Lahijani S, Martin S, Niazi SK, Pailler M, Parnes F, Rao V, Salman J, Scher E, Schuster J, Teply M, Usher A, Valentine AD, Vanderlan J, Lyons MS, McMillian NR, Darlow SD (May 2023). "NCCN Guidelines® Insights: Distress Management, Version 2.2023". J Natl Compr Canc Netw. 21 (5): 450–457. doi:10.6004/jnccn.2023.0026. PMID 37156476 Check |pmid= value (help).

[urlValidate_User-10] [+https://jamanetwork.com/journals/jama/article-abstract/2788136 "Validate User"] Check |url= value (help).

[pmid31868151-11] 11.0 ^11.1 ^11.2 ^11.3 Farsad M (2020). "FDG PET/CT in the Staging of Lung Cancer". Curr Radiopharm. 13 (3): 195–203. doi:10.2174/1874471013666191223153755. PMC 8206197 Check |pmc= value (help). PMID 31868151.

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[pmid39806071-13] Black JR, Bartha G, Abbott CW, Boyle SM, Karasaki T, Li B, Chen R, Harris J, Veeriah S, Colopi M, Bakir MA, Liu WK, Lyle J, Navarro FC, Northcott J, Pyke RM, Hill MS, Thol K, Huebner A, Bailey C, Colliver EC, Martínez-Ruiz C, Grigoriadis K, Pawlik P, Moore DA, Marinelli D, Shutkever OG, Murphy C, Sivakumar M, Shaw JA, Hackshaw A, McGranahan N, Jamal-Hanjani M, Frankell AM, Chen RO, Swanton C (January 2025). "Ultrasensitive ctDNA detection for preoperative disease stratification in early-stage lung adenocarcinoma". Nat Med. 31 (1): 70–76. doi:10.1038/s41591-024-03216-y. PMC 11750713 Check |pmc= value (help). PMID 39806071 Check |pmid= value (help).

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