Schaefer-Prokop C
Academic Medical Center, Meibergdreef 9, NL-1105, Amsterdam, Niederlande.
Radiologe. 2010 Aug;50(8):675-83. doi: 10.1007/s00117-009-1958-0.
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.
近年来,数字放射成像以及多排螺旋计算机断层扫描(MDCT)领域取得了多项重要技术进展,这些进展改善了支气管癌的检测和分期。诸如时间减影、肋骨抑制、双能减影或计算机辅助检测(CAD)等精细处理的目的是帮助放射科医生尽早发现肺部肿瘤。对于CT和放射成像技术而言,鉴别真阳性和假阳性病变似乎是最大的挑战。具有多平面投影功能的MDCT是评估局部肿瘤扩散范围(T分期)的首选成像方法,而N分期和M分期则是正电子发射断层扫描(PET)甚至是PET/CT一体机的优势领域。CT中实性和半实性病变随访的管理规则考虑了患者的风险,并在国际指南中进行了总结。2009年出版了新版(第7版)TNM分类,其中除其他方面外,更具体地对肿瘤大小进行了亚分类,肿瘤叶内卫星结节的存在被降为T3期,且不再决定肿瘤的可切除性。N分期未作修改。最重要的新特点之一是,新分类不再仅适用于非小细胞肺癌(NSCLC),也适用于小细胞肺癌(SCLC)和类癌肿瘤。