新版肺癌 8 分期系统及其在 CT 图像解读中的潜在陷阱和局限性:实例演示
The new 8th TNM staging system of lung cancer and its potential imaging interpretation pitfalls and limitations with CT image demonstrations.
机构信息
Department of Radiology, China Medical University Hospital, Taichung, Taiwan.
Department of Radiology, China Medical University Hospital, Taichung, Taiwan;School of Chinese Medicine, China Medical University, Taichung, Taiwan.
出版信息
Diagn Interv Radiol. 2019 Jul;25(4):270-279. doi: 10.5152/dir.2019.18458.
The tumor, node, metastasis (TNM) staging system approved by International Association for the Study of Lung Cancer (IASLC) and the American Joint Committee on Cancer (AJCC) to stage lung cancer was recently revised. The latest revision is the 8th edition published in January, 2017. This new edition made some important changes to the previous edition, including modification of the T classification based on 1 cm increment, downstage of T descriptor including endobronchial tumor disregarding its distance from carina (T2), merging total and partial atelectasis/pneumonitis into the same T category (T2), upstage diaphragmatic invasion to T4, new classification concept of adenocarcinoma in situ and minimally invasive adenocarcinoma for pure and part-solid ground-glass nodules, and further division of extrathoracic metastasis into M1b and M1c based on the number and sites of extrathoracic metastases. Consensus is reached for debating situations not covered in the previous edition of staging system, such as the classification of pancoast tumor based on its invasion depth and staging tumors that extend directly across the fissure as T2a. Classification of multiple sites of pulmonary involvement, including multiple primary lung cancer, separate lung cancer nodules, multiple ground-glass or lepidic lesions, and consolidation, is also discussed. Even though the 8th edition of the TNM lung staging system provides us with more precise classification based on prognostic analysis of each TNM descriptors, there are still some potential limitations and clinical situations that have not yet been clarified in terms of clinical staging by imaging. It is important for radiologists to understand the major changes introduced in the 8th edition of TNM staging and to recognize the potential pitfalls and limitations of imaging interpretation to precisely classify the clinical stage of lung cancer.
国际肺癌研究协会(IASLC)和美国癌症联合委员会(AJCC)批准的肿瘤、淋巴结、转移(TNM)分期系统最近进行了修订。最新的修订版是 2017 年 1 月出版的第 8 版。该新版本对前一版本进行了一些重要修改,包括基于 1cm 增量修改 T 分类、将包括隆突以内的支气管内肿瘤的 T 描述符降期(T2)、将全肺和部分性肺不张/肺炎合并为同一 T 类别(T2)、将膈肌侵犯升级为 T4、将原位腺癌和微浸润性腺癌的新分类概念用于纯磨玻璃结节和部分实性磨玻璃结节、根据胸外转移的数量和部位将胸外转移进一步分为 M1b 和 M1c。对于分期系统前一版未涵盖的辩论情况,如基于侵袭深度的胸廓上口肿瘤分类和直接跨越裂孔的肿瘤分期为 T2a,达成了共识。还讨论了多个肺部受累部位的分类,包括多原发肺癌、孤立性肺癌结节、多个磨玻璃或贴壁病变以及实变。尽管第 8 版 TNM 肺癌分期系统为每个 TNM 描述符的预后分析提供了更精确的分类,但在影像学临床分期方面仍存在一些潜在的局限性和尚未阐明的临床情况。放射科医生了解第 8 版 TNM 分期中引入的主要变化,并认识到影像学解释的潜在陷阱和局限性,对于准确分类肺癌的临床分期非常重要。