What is the role of CT scanning in the staging of non-small cell lung cancer (NSCLC)?

Updated: Aug 27, 2019
  • Author: Sat Sharma, MD, FRCPC; Chief Editor: Eugene C Lin, MD  more...
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CT scans may be useful in evaluating primary tumors. Although the size of the tumor, whether the lesion is T1 or T2, may not change the surgical approach, the site of the tumor is important to identify.

CT scans may be helpful in determining tumor extension across the major fissure.

CT scans are useful in assessing local invasion of the chest wall, mediastinum, mainstem bronchus, central veins, and arteries. Signs of chest wall invasion include bone destruction, tumor extension into the chest wall, pleural thickening, and loss of extrapleural fat plane.

Identification of mediastinal invasion with CT usually is unreliable. In addition, minimal mediastinal fat invasion may be resectable in many cases. Tumor invasion of the central arteries and veins may be identified by using CT, which indicates that a pneumonectomy is required. Tumor invasion of the mainstem bronchus can also be visualized on CT scans. This is a useful finding for planning the surgical procedure.

CT is a useful radiologic modality for noninvasive anatomic evaluation of the hila and mediastinum. The indication of metastasis is primarily based on size criteria. A lymph node with a short-axis diameter of more than 1 cm is defined as enlarged. Although the probability of metastasis increases with increasing lymph node size, CT scanning is not helpful in differentiating a metastasis from a benign lesion.

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