Radiologic clinics of North America
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This article reviews regional lymph node assessment in lung cancer. In the absence of a distant metastasis, the absence or location of lung cancer spread to a regional mediastinal lymph node affects treatment options and prognosis. ⋯ The International Association for the Study of Lung Cancer lymph node map is used for the standardization of N descriptor assessment. CT, PET/CT with fluorodeoxyglucose, endobronchial ultrasound-guided and/or esophageal ultrasound-guided biopsy, and mediastinoscopy are common modalities used to determine the N descriptor.
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Radiol. Clin. North Am. · May 2018
ReviewPulmonary Nodule Management in Lung Cancer Screening: A Pictorial Review of Lung-RADS Version 1.0.
The number of screening-detected lung nodules is expected to increase as low-dose computed tomography screening is implemented nationally. Standardized guidelines for image acquisition, interpretation, and screen-detected nodule workup are essential to ensure a high standard of medical care and that lung cancer screening is implemented safely and cost effectively. In this article, we review the current guidelines for pulmonary nodule management in the lung cancer screening setting.
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Radiol. Clin. North Am. · May 2018
ReviewManagement of Incidental Lung Nodules: Current Strategy and Rationale.
Incidentally detected lung nodules are increasingly common in routine diagnostic computed tomography (CT) imaging. Formal management recommendations for incidental nodules, such as those outlined by the Fleischner Society, must therefore reflect a balance of malignancy risk and the clinical context in which nodules are discovered. Nodule size, attenuation, morphology, and location all influence the likelihood of malignancy and, thus, the necessity and timing of follow-up according to current Fleischner recommendations. As technological advancements in CT imaging continue, there may be greater reliance on advanced computerized analysis of lung nodule features to help determine the risk of clinically significant disease.
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The advent of the 8th edition of the lung cancer staging system reflects a further meticulous evidence-based advance in the stratification of the survival of patients with lung cancer. Although addressing many limitations of earlier staging systems, several limitations in staging remain. This article reviews from a radiological perspective the limitations of the current staging system, highlighting the process of TNM restructuring, the residual issues with regards to the assignment of T, N, M descriptors, and their associated stage groupings and how these dilemmas impact guidance of multidisciplinary teams taking care of patients with lung cancer.