Patterns of nodal spread in thoracic malignancies

Transcription

1 Patterns of nodal spread in thoracic malignancies Poster No.: C-0977 Congress: ECR 2010 Type: Educational Exhibit Topic: Chest Authors: R. dos Santos, M. Duarte, J. Alpendre, J. Castaño, Z. Seabra, Â. Marques; Lisbon/PT Keywords: thoracic malignancies, nodal spread, N staging DOI: /ecr2010/C-0977 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 34

2 Learning objectives To illustrate the patterns of lymphatic spread from different primary thoracic malignancies. Background Different primary malignancies have different lymphatic drainage pathways. Proper assessment of nodal spread requires careful evaluation of specific pathways. CT is the primary imaging modality for the diagnosis, staging and follow-up of thoracic malignancies. It is a non-invasive, available diagnostic tool which allows determination of the most appropriate method for nodal sampling and helps in the detection of recurrent disease. Imaging findings OR Procedure details THORACIC NODAL STATIONS 1,2,3,4 Page 2 of 34

3 Fig.: Thoracic nodal stations - Illustrative drawing Page 3 of 34

4 Fig.: Thoracic nodal stations - Illustrative drawing Page 4 of 34

5 Fig.: Thoracic nodal stations - Illustrative drawing 1,2,3,4 TDM CRITERIA FOR ADENOPATHIES Page 5 of 34

6 Fig.: TDM criteria for adenopathies The small axis of a lymph node is the most reproducible measurement. However, nodal size alone is not reliable to indicate metastatic involvement. Number, morphology, attenuation and uptake patterns are also helpful features to the detection of abnormal lymph nodes, since the nodal metastases commonly demonstrate the same 5 dynamic behaviour as the primitive lesion. 5 CT and FDG PET are most useful in the evaluation of thoracic adenopathies. Page 6 of 34

7 Fig.: Methods of study - CT and FDG PET MRI is globally as helpful as CT, but it is not widely available, it is time consuming and more expensive than CT. However, it is more useful than CT in the evaluation of superior sulcus tumors for detection of invasion of the brachial plexus or vertebral bodies. Both CT and FDG PET are valuable in the diagnosis of adenoathies, with some 5 differences in overall sensitivity, specificity, positive and negative predictive values. Page 7 of 34

8 Fig.: Diagnostic accuracy - CT vs FDG PET. Toloza et al, in Chest The accurate location of thoracic adenopathies helps deciding the best sampling 4 approach. Page 8 of 34

9 Fig.: Nodal accessibility for sampling One of the advantages of CT is the great anatomical resolution and ability to accurately locate adenopathies, which are very helpful in the choice for the best method for nodal sampling. Also, every thoracic nodal station can be potentially assessed under CT guidance. ############################################# These stations can be applied to primitive thoracic tumors, such as - lung - breast - esophagus Page 9 of 34

10 - pleura - lymphomas. 5 However, lymph node regions other than those mentioned above can also be involved. Lung, lymphoma, esophagus, mesothelioma and breast malignancies have specific lymphatic drainage pathways, which can be easily assessed with CT. LUNG CARCINOMA 5 Fig.: Lung Cancer Page 10 of 34

11 Fig.: Lung Cancer Page 11 of 34

12 Fig.: Lung Cancer Page 12 of 34

13 Fig.: Lung Cancer Page 13 of 34

14 Fig.: Lung Cancer Page 14 of 34

15 Fig.: Lung Cancer Page 15 of 34

16 Fig.: Lung Cancer Page 16 of 34

17 Fig.: Lung Cancer Page 17 of 34

18 Fig.: Lung Cancer Page 18 of 34

19 Fig.: Lung Cancer 5 HODGKIN AND NON-HODGKIN LYMPHOMA Page 19 of 34

20 Fig.: Lymphomas Page 20 of 34

21 Fig.: Hodgkin Lymphoma Page 21 of 34

22 Fig.: Non-Hodgkin Lymphoma 5 ESOPHAGEAL CARCINOMA Page 22 of 34

23 Fig.: Esophageal Cancer Page 23 of 34

24 Fig.: Esophageal Cancer Page 24 of 34

25 Fig.: Esophageal Cancer Page 25 of 34

26 Fig.: Esophageal Cancer Page 26 of 34

27 Fig.: Esophageal Cancer Page 27 of 34

28 Fig.: Esophageal Cancer 5 MESOTHELIOMA Page 28 of 34

29 Fig.: Mesothelioma Page 29 of 34

30 Fig.: Mesothelioma Page 30 of 34

31 Fig.: Mesothelioma 5 BREAST CARCINOMA Page 31 of 34

32 Fig.: Breast Cancer Page 32 of 34

33 Fig.: Breast cancer Conclusion Awareness of the pathways of lymphatic drainage from different thoracic malignancies allows better assessment of involvement of specific nodal stations of the different tumors and is a precious aid for accurate staging, treatment and follow-up of patients with thoracic malignancies. Personal Information Page 33 of 34

34 Rosana dos Santos; Radiology Resident Lisbon Portugal The authors thank the graphic artist who provided the drawings. References 1. Lee jkt, sagel s, stanley rj, heiken jp. Retroperitoneum. Computed body tomography with MRI correlation Webb wr, brant we, major nm. Mediastinum: vascular abnormalities, peritoneal cavity, vessels, nodes, and abdominal wall. Fundamentals of body ct. 2006; 29-48, Prokop m, galansky m, et altri. Vascular system. Spiral and multislice computed tomography of the body Radiology assistant 5. Sharma a., Fidias p., Patherns of lymphadenopathy in thoracic malignancies; radigraphics 2004; 24: Page 34 of 34