Zusammenfassung
Technische Verbesserungen der letzten Jahre auf dem Gebiet der digitalen Radiographie wie der CT-Technik haben die Detektion und das Staging des Bronchialkarzinoms verbessert. Ziel neuer Nachverarbeitungen wie temporale Subtraktion, Rippensubtraktion sowie computerunterstützte Detektion („computer-aided detection“, CAD) ist, dem Radiologen zu helfen, pulmonale Tumoren in einem möglichst frühen Stadium zu erkennen. Dabei erweist sich – ähnlich wie in der CT – die Differenzierung falsch-positiver von wahren Läsionen als die größte Herausforderung. Die Multidetektor-CT (MDCT) mit ihren multiplanaren Möglichkeiten ist die Methode der Wahl zur Erfassung der lokalen Tumorausdehnung (T-Stadium), während das Lymphknotenstaging (N-Stadium) und der Nachweis okkulter Fernmetastasen (M-Stadium) Domäne der Positronenemissionstomographie (PET), besser noch der integrierten PET/CT sind. In welchen Zeitabständen und wie oft solide und semisolide pulmonale Herde zu kontrollieren sind, hängt vom Risiko der Patienten ab und ist in internationalen Richtlinien zusammengefasst.
Im Jahr 2009 ist die 7. Fassung des TNM-Stadiums veröffentlicht worden, die u. a. die Tumorgröße weiter differenziert und die Präsenz eines Satellitenherdes im Tumorlappen als T3 ansieht und damit nicht mehr zum Spielball der möglicher Tumorresektabilität macht. Das N-Staging wurde nicht modifiziert. Als wichtige Neuerung gilt, dass die neue Klassifikation nicht mehr nur für das nichtkleinzellige, sondern auch für das kleinzellige Karzinom und das Karzinoid gilt.
Abstract
A number of important technical advances made in recent years in the area of both digital radiography as well as multidetector computed tomography (MDCT) have improved detection and staging of bronchial carcinoma. The aim of elaborate processing such as temporal subtraction, rib suppression, dual energy subtraction or CAD is to aid the radiologist in detecting lung tumors at the earliest stage possible. For both CT and radiography techniques the differentiation between true and false positive lesions seems to be the biggest challenge. MDCT with multiplanar projections is the imaging method of choice for staging of the extent of local tumor spread (T staging), while N staging and M staging are the domain of positron emission tomography (PET) or even better of integrated PET/CT. Management rules for follow-up of solid and semi-solid lesions seen in CT consider the risks of the patient and are summarized in international guidelines.
In 2009 a new 7th edition of the TNM classification was published, which, among other aspects, sub-classifies tumor size more specifically and the presence of a satellite nodule in the tumor lobe is down-staged to T3 and no longer determines tumor resectability. The N staging was not modified. One of the most important new features is the fact that the new classification no longer applies only to non-small cell lung cancer (NSCLC) but also to SCLC and carcinoid tumors.
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Literatur
Levin ML, Tockman MS, Frost JK, Ball JWC (1982) Lung cancer mortality in males screened by chest X-ray and cytologic sputum examination: a preliminary report. Recent Results Cancer Res 82:138–146
Melamad MR, Flehinger BJ, Zaman MB et al (1984) Screening for early lung cancer: results of the memorial sloan-kettering study in New York. Chest 86:44–53
Hoop B de, Schaefer-Prokop C, Gietema HA et al (2010) Screening for lung cancer with digital chest radiography: sensitivity and number of secondary work-up CT examinations. Radiology 255(2):629–637
Austin JH, Romney BM, Goldsmith LS (1992) Missed bronchogenic carcinoma: radiographic findings in 27 patients with a potentially resectable lesion evident in retrospect. Radiology 182(1):115–122
Szucs-Farkas Z, Patak MA, Yuksel-Hatz S et al (2008) Single – exposure dual-energy subtraction chest radiography: detection of pulmonary nodules and masses in clinical practice. EJR 18(1):24–31
Kashani H, Varon CA, Paul NS et al (2010) Diagnostic performance of a prototype dual-energy chest imaging system ROC analysis. Acad Radiol 17(3):298–308
Li F, Engelmann R, Doi K, MacMahon H (2009) Improved detection of small lung cancers by use of bone suppression with dual-energy subtraction chest radiographs. RSNA abstract SSG03–02, 433
MacMahon H, Armato SG (2009) Temporal subtraction chest radiography. Eur J Radiol 72:238–243
Kakeda S, Nakamura K, Kamada K et al (2002) Improved detection of lung nodules by using a temporal subtraction technique. Radiology 224:145
Boo DW de, Prokop M, Uffmann M et al (2009) Computer-aided detection (CAD) of lung nodules and small tumors. EJR 72:218–225
Hoop B de, Boo D de, Gietema H et al (n d) Computer-aided detection of lung cancer on CXR: the effect of CAD on human observer performance. Radiology, in press
Bley TA, Baumann T, Saueressig U et al (2008) Comparison of radiologist and CAD performance in the detection of CT confirmed subtle pulmonary nodules on digital chest radiographs. Invest Radiol 43 (suppl 16):343-348
Beigelman-Aubry C, Hill C, Grenier PA (2007) Management of an incidentally discovered nodule. Eur Radiol 17:449–466
Marten K, Engelke C (2007) Computer-aided detection and automated CT volumetry of pulmonary nodules. Eur Radiol 17:888–901
Gietema H, Schaefer-Prokop C, Mali W et al (2007) Pulmonary nodules: interscan variability of semiautomated volume measurements with multisection CT – influence of inspiration level, nodule size and segmentation performance. Radiology 245:888–894
Ahn MI, Gleeson TG, Chan IH et al (2010) Perifissural nodules seen at CT screening for lung cancer. Radiology 254(3):949–956
Gody MCB, Naidich DP (2009) Subsolid pulmonary ndoules and the spectrum of peripheral adenocarcinomas of the lung: recommended interim guidelines for assessment and management. Radiology 253(3):606–622
Kostis WJ, Yankelevitz DF, Reeves AP et al (2004) Small intrapulmonary nodules: reproducibility of three-dimensional volumetric measurement and estimation of time to follow-up CT. Radiology 231:446–452
MacMahon H, Austin JHM, Gamsu G et al (2005) Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner society. Radiology 237:395–400
Kligerman S, Abbott G (2010) A radiologic review of the new TNM classification for lung cancer. AJR 194:562–573
Rami-Porta R, Crowley JJ, Goldstraw P (2009) The rvised TNM staging system for lung cancer. Ann Thorac Vardiovas Surg 15(1):4–9
Erasmus JJ, Truong MT, Munden RF (2005) CT, MR and PET imaging in staging of non-small-cell lung cancer. Semin Roentgenol 40(2):126–142
Kim YS, Lee MK, Kim SJ et al (2010) Prognostic stratification using F-18 FDG PET/CT in patients with advanced stage (stage III and IV) non-small cell lung cancer. Neoplasma 57(3):241–246
Tanvetyanon T, Eikman EA, Sommers E et al (2008) Computed tomography response, but not positron emission tomography scan response predicts survival after neoadjuvant chemotherapy for resectable NSCLC. J Clin Oncol (26):28:4610–4616
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Schaefer-Prokop, C. Konventionelle und CT-Diagnostik des Bronchialkarzinoms. Radiologe 50, 675–683 (2010). https://doi.org/10.1007/s00117-009-1958-0
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DOI: https://doi.org/10.1007/s00117-009-1958-0