In the combined TNM/VALSG approach for staging of SCLC, T1and T2 lesions and M1a ipsilateral pleural disease correspond with LS-SCLC. T3 and T4 lesions are conditional and may be LS or ES depending on the feasibility of inclusion within a single radiation port. Other M descriptors, including M1a contralateral pleural effusion, M1a pericardial effusion, M1b, and M1c comprise ES-SCLC [54]. CT Chest For patients with known or suspected SCLC, chest CT with IV contrast is recommended. If concurrent CT abdomen is not obtained, the adrenal glands should be covered. Chest CT without IV contrast may also be used. Chest CT is the modality of choice for initial evaluation of the SCLC. A large percentage of SCLCs arise from the central lobar or main bronchi. Consequently, the most common appearance of SCLC on imaging studies is a centrally located lung mass or mediastinal mass with hilar involvement [50]. In two-thirds of patients, tumor Noninvasive Clinical Staging of Primary Lung Cancer tissue encases mediastinal structures, including vessels, airways, and the esophagus [50]. Diagnosis of chest wall invasion on CT can be equivocal in cases of minimal invasion. Radiologic imaging cannot dependably detect visceral pleural invasion. Chest CT with IV contrast can aid in the identification of chest wall invasion by tumor, assessment of extent of mediastinal invasion, evaluation of additional mediastinal and hilar lymph nodes, distinction of central obstructing tumor from surrounding atelectasis, and assessment for liver metastases [50,51]. Unenhanced CT may be better able to characterize adrenal nodules. CT Abdomen and Pelvis CT abdomen and pelvis with oral and IV contrast is recommended in conjunction with CT chest to evaluate for extrathoracic metastasis in SCLC patients. Acquisition of arterial and portal venous phase sequences is advised. CT abdomen without IV contrast may also be obtained. Dual-phase imaging may be useful in this clinical setting.
Noninvasive Clinical Staging of Primary Lung Cancer PCAs. In the combined TNM/VALSG approach for staging of SCLC, T1and T2 lesions and M1a ipsilateral pleural disease correspond with LS-SCLC. T3 and T4 lesions are conditional and may be LS or ES depending on the feasibility of inclusion within a single radiation port. Other M descriptors, including M1a contralateral pleural effusion, M1a pericardial effusion, M1b, and M1c comprise ES-SCLC [54]. CT Chest For patients with known or suspected SCLC, chest CT with IV contrast is recommended. If concurrent CT abdomen is not obtained, the adrenal glands should be covered. Chest CT without IV contrast may also be used. Chest CT is the modality of choice for initial evaluation of the SCLC. A large percentage of SCLCs arise from the central lobar or main bronchi. Consequently, the most common appearance of SCLC on imaging studies is a centrally located lung mass or mediastinal mass with hilar involvement [50]. In two-thirds of patients, tumor Noninvasive Clinical Staging of Primary Lung Cancer tissue encases mediastinal structures, including vessels, airways, and the esophagus [50]. Diagnosis of chest wall invasion on CT can be equivocal in cases of minimal invasion. Radiologic imaging cannot dependably detect visceral pleural invasion. Chest CT with IV contrast can aid in the identification of chest wall invasion by tumor, assessment of extent of mediastinal invasion, evaluation of additional mediastinal and hilar lymph nodes, distinction of central obstructing tumor from surrounding atelectasis, and assessment for liver metastases [50,51]. Unenhanced CT may be better able to characterize adrenal nodules. CT Abdomen and Pelvis CT abdomen and pelvis with oral and IV contrast is recommended in conjunction with CT chest to evaluate for extrathoracic metastasis in SCLC patients. Acquisition of arterial and portal venous phase sequences is advised. CT abdomen without IV contrast may also be obtained. Dual-phase imaging may be useful in this clinical setting.