Goldstraw P. International Association for the Study of Lung Cancer Staging Manual in Thoracic Oncology. Although the 3-cm cutpoint still remains a landmark to separate T1 from T2 tumors, the survival analyses showed that a progressive degradation of survival was observed for each 1-cm cutpoint. It also reclassified diaphragm invasion as a T4 descriptor. Abstract. anatomic and metabolic imaging, endoscopies and minimally invasive surgical procedures, should be performed sequentially and with an increasing degree of invasiveness. Use of CT to evaluate pleural invasion in non-small cell lung cancer: measurement of the ratio of the interface between tumor and neighboring structures to maximum tumor diameter. Regional lymph node maps … Link, Google Scholar; 9 Pieterman RM, van Putten JWG, Meuzelaar JJ, et al. In the absence of a distant metastasis, the absence or location of lung cancer spread to a regional mediastinal lymph node affects treatment options and prognosis. Ann Thorac Surg 1996; 62:338-341. Lung cancer has increased in incidence throughout the twentieth century and is now the most common cancer in the Western World. The techniques for clinical staging, i.e. Lung cancer staging: clinical and radiologic perspectives. We’ll tell you all about treatments, staging, symptoms, survival rates, and more. However, note that the site of the metastasis by itself is not a prognostic factor 4. (A) Contrast-enhanced CT scan obtained at left atrial level shows a mass, Superior sulcus tumor (adenocarcinoma). The IASLC (International Association for the Study of Lung Cancer) 8th edition lung cancer staging system was introduced in 2016 and supersedes the IASLC 7th edition. Crossref, Medline, Google Scholar; 17 Nakanishi R, Yasumoto K. Combined thoracoscopy and mediastinoscopy for mediastinal lymph node staging of lung cancer. Int Surg 1996; 81:359-361. Journal of Thoracic Imaging: May 2006 - Volume 21 - Issue 2 - p 123-136. There is a recommendation that the number of metastatic lesions, the larger diameter of individual metastatic deposits, and the number of involved organs should be stated in the radiological report 3. PET-CT plays an important role in staging nodal disease. It doesn't show on scans but there might be cancer cells present in spit or in fluid taken from the lung.T0 means there is no sign of cancer.Tis means an area of cancer cells contained within the inner lining of the lungs. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer Peter Goldstraw and others for the Study of Lung Cancer Staging and Prognostic Factors Committee Journal of Thoracic Oncology, 2015. Abstract: Lung cancer is the leading cause of cancer death in both men and women. Preoperative staging of non-small cell lung cancer with positron-emission tomography. This new edition … BTS guideline; Fleischner 2017 guideline; Solitary Pulmonary Nodule. Buy; Abstract . This is a summary of the 8th Edition of TNM in Lung Cancer, which is the standard of non-small cell lung cancer staging since January 1st, 2017. The latest revision is the 8th edition published in January, 2017. Specific properties of each of the T, N, and M subtypes as proposed by this revision are shown in Table 18.2 . 2. Correct staging is essential to tailor optimal management and choose the appropriate therapy with lowest mortality and morbidity for the individual patient. Primary pulmonary carcinoma may be unresectable (T4) if it invades the heart, great vessels, or the vertebral body. Lung cancer staging is a validated tool that involves careful identification of the tumor, lymph node involvement, and metastatic spread. (B) Axial T2W triple inversion black-blood MR image obtained at similar level to (A) demonstrates a right upper lobe mass and accompanying post–obstructive pneumonia. Cancer of the lung is the leading cause of cancer mortality in men and women in the United States. Accurate staging is important to define operability, select treatment regimens, and predict survival. Lung cancer is the second leading cause of death, behind heart disease. Mediastinal pleural invasion without mediastinal tissue invasion is difficult to determine clinically and is rare at pathologic staging; therefore the new IASLC staging deleted mediastinal pleural invasion as a T descriptor. Crossref, Medline, Google Scholar; 13 Patz Jr EF, Erasmus JJ, McAdams HP, et al. Staging. Nonsurgical and surgical techniques are used to stage patients. Total atelectasis or pneumonitis, a T3 descriptor in the seventh edition, showed better prognosis than other T3 tumors in the new IASLC database; therefore the IASLC project provided grouping of partial and total atelectasis/pneumonitis as a T2 descriptor. Preoperative staging of non-small cell lung cancer with positron-emission tomography. Standard-of-care lung cancer staging ideally should be performed in a multidisciplinary meeting using the information provided both from CT and FDG-PET/CT with further inputs from the histopathologic findings (pathological staging). The following represents the most widely accepted criteria for radiologic assessment. Stage classification provides a nomenclature about the anatomic extent of a cancer; a consistent language provides the ability to communicate about a specific patient and about cohorts of patients in clinical studies. (Reprinted with permission from the International Association for the Study of Lung Cancer. Chheang S(1), Brown K(2). (B) Coronal-reformation CT image shows an oval mass in the right upper lobe. The eighth edition of the TNM Classification for Lung Cancer was proposed by the International Association for the Study of Lung Cancer (IASLC). Standard-of-care lung cancer staging ideally should be performed in a multidisciplinary meeting using the information provided both from CT and FDG-PET/CT with further inputs from the histopathologic findings (pathological staging). Tumor encircles the truncus anterior, MRI in squamous cell lung carcinoma. Therefore the new IASLC database provided that T3 tumors classified by endobronchial location were combined as T2 tumor. The seventh edition of the TNM classification of lung cancer, published in 2009, was based on the analysis of a retrospective international database collected from 1990 to 2000 by the International Association for the Study of Lung Cancer (IASLC) ( Table 18.1 ). Radiology 2007;242(2):555–562. The collection also includes discussion questions, an action plan, a quiz, and other resources to help you develop your own lung cancer screening program. Low cervical, supraclavicular and sternal notch nodes, Paraaortic nodes (ascending aorta or phrenic), TUMOR-NODE-Metastasis CLINICAL CLASSIFICATION (SEVENTH EDITION), PROPOSED TUMOR-NODE-Metastasis CLINICAL CLASSIFICATION (EIGHTH EDITION), PROPOSED STAGE GROUPINGS FOR THE EIGHTH EDITION OF THE TUMOR-NODE-Metastasis CLASSIFICATION FOR LUNG CANCER, T4 squamous cell carcinoma with surgically proven chest wall and right hemidiaphragmatic invasion. 1. The precise clinical staging of lung cancer is of particular importance as it determines prognosis and guides therapy. 2013 … The National Comprehensive Cancer Network (NCCN) guidelines recommend that FDG-PET/CT should be offered to all patients with non-small cell lung cancer (NSCLC) and that PET-positive findings for mediastinal nodes and/or distant disease require histopathological or other radiological confirmation 4. It has been shown to be more useful than CT alone in determining the T stage of the primary tumor and in assessing chest wall invasion. … In a few patients, however, multiple microscopic examinations of pleural (pericardial) fluid are negative for tumor, and the fluid is nonbloody and is not an exudate. The various combinations of T, N, and M that define different stages are depicted in Table 18.3 . By stage IV, the cancer is considered advanced and has spread to other areas of the body. (A) CT scan obtained at level of liver dome shows enhancing, heterogeneous mass in the right lower lobe, abutting the chest wall. In medicine, lung cancer staging is the assessment of the extent to which a lung cancer has spread from its original source. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. Stage grouping. It is issued by the IASLC (International Association for the Study of Lung Cancer) and replaces the TNM 7th edition. [1] TABLE 1. T (tumor), N (node), and M (metastasis) (TNM) system is used for determining tumor subgrouping and staging for lung cancer. MRI may allow better delineation of mediastinal and superior sulcus invasion ( Fig. Staging non-small cell lung cancer with whole-body PET. Lung cancer remains the leading cause of cancer-related mortality worldwide. Lung cancer remains the leading cause of cancer-related deaths in the US. Contrast-enhanced axial CT scan obtained at the level of the great vessels shows a large left upper lobe heterogeneous mass invading the adjacent vertebral body, T4 squamous cell lung cancer showing descending thoracic aortic invasion. On the basis of the new IASLC database, the following rearrangement of T descriptors was provided: T1 tumors were subdivided into three subgroups at 1-cm cutpoints; T2 tumors were subdivided into two subgroups; T2 tumors greater than 5 cm and less than or equal to 7 cm were reclassified as T3; T3 tumors greater than 7 cm were reclassified as T4 (see Table 18.2 ). b Most pleural (pericardial) effusions with lung cancer are due to tumor. After completing this journal-based SA-CME activity, participants will be able to: 1. Preoperative tumor staging in patients with known or suspected non-small cell lung cancer is generally performed using contrast enhanced chest computed tomography (CT) (including the adrenal glands). 8 Marom EM, McAdams PH, Erasmus JJ, et al. Revisions to the TNM Staging of Lung Cancer: Rationale, Significance, and Clinical Application. Coronal images are particularly helpful in the assessment of tumor extension into the subcarinal region, aortopulmonary window, and superior vena cava. Staging non-small cell lung cancer with whole-body PET. A proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. Following diagnosis of lung cancer, accurate staging is essential to guide clinical management and inform prognosis. It is the leading cause of cancer mortality worldwide; accounting for ~20% of all cancer deaths 1. It may also show the presence of pleural effusion and, in some cases, evidence of chest wall or mediastinal invasion. Lung cancer staging and management: comparison of contrast-enhanced and nonenhanced helical CT of the thorax. Magnetic resonance imaging (MRI) is superior to CT in the demonstration of the pericardium, cardiac chambers, and mediastinal vessels, with the added advantage of not requiring intravenous (IV) contrast medium. ORIGINAL ARTICLE Clinical T category for lung cancer staging: A pragmatic approach for real-world practice Yeonu Choi1†, Sun-Hyung Kim2†, Ki Hwan Kim1, Yeonseok Choi2, Sung Goo Park1, Insuk Sohn3, Hye Seung Kim, Sang-Won Um2 & Ho Yun Lee1 1 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea According to the studies with comparison of PET-MRI and PET-CT in the preoperative staging of NSCLC, the diagnostic accuracy of PET-MRI (65%–94.3%) in the T staging was comparable to that of PET-CT (70%–91.4%). Related content. Chest radiography is generally unreliable in detecting invasion of the chest wall, diaphragm, or mediastinum. Squamous cell lung carcinoma is a type of non-small cell lung cancer. ■ Discuss the roles of CT and PET/CT in evaluating patients with small cell lung carcinoma. Although those lesions that are part solid should be measured on both their largest average diameter and the largest diameter of the solid component, only the solid component measurement is to be used for staging directions 3. Staging also allows more accurate prediction of … MRI is especially useful in the evaluation of brachial plexus, subclavian vessel, or vertebral body invasion in Pancoast tumors. To play an important role in the multidisciplinary management of lung cancer patients, it is necessary that the radiologist understands the principles of staging and the implications of radiological findings on the various staging descriptors and eventual treatment decisions. Diese 7. The presence of pulmonary carcinoma is often first suspected on the chest radiograph. Author information: (1)Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York - Presbyterian Hospital, New York, New York. Histologic diagnosis is recommended when the adrenal gland is the only site of metastatic disease, given the risk of a false-positive 4. Imai K, Minamiya Y, Ishiyama K, et al. Check for errors and try again. For those centrally located lung tumors associated with peripheral post-obstructive atelectasis, FDG-PET/CT is useful in further delineating the tumor real size and, therefore, leads to a more precise T staging and, if it is the case, to a smaller targeted volume in radiation treatment planning. 2. This is an on-going project and version 7 does not include information from newer developments such as positron emission tomography-computed tomography (PET-CT) scanning. Despite the unique morphology of cystic lung cancer, staging is performed according to the ‘standard’ TNM 8 th edition, which stages patient groups based on their prognosis. In this context, the newly introduced PET-MRI system with superior soft tissue contrast and dedicated sequences has the potential to compensate the shortcomings of PET-CT. Integrated PET-CT provides morphologic as well as metabolic data of lung cancer and is widely accepted to be the first-line imaging tool for staging. 18.3 ), main or proximal portion of the right or left pulmonary arteries, or the esophagus. Methods: This study was approved by the institutional review board and by national government authorities. ■ Describe the staging of small cell lung carcinoma using the Veterans Administration Lung Cancer Study Group and American Joint Committee on Cancer TNM staging systems. Purpose: To evaluate prospectively the accuracy of integrated positron emission tomography (PET) and computed tomography (CT) with use of fluorodeoxyglucose (FDG), compared with that of stand-alone CT, for the preoperative staging of non-small cell lung cancer, with surgical and histologic findings used as the reference standard. N Engl J Med 2000; 343:254-261. The IASLC (International Association for the Study of Lung Cancer) 8 th edition lung cancer staging system was introduced in 2016 and supersedes the IASLC 7 th edition. Care at Mayo Clinic. Orange Park, FL: Editorial Rx Press; 2009. Imaging plays an important role in the diagnosis, staging, and follow-up evaluation of patients with lung cancer. Department of Radiology of the Academical Medical Centre, Amsterdam and the Alrijne Hospital, Leiderdorp, the Netherlands. MRI is superior to CT in the demonstration of the pericardium, cardiac chambers, and mediastinal vessels with the added advantage of not requiring IV contrast medium (see Fig. Lung Cancer Screening Recommendations Achieving world-class quality through clinical and operational collaboration on a national scale. b Solitary adenocarcinoma, ≤3 cm with a predominantly lepidic pattern and ≤5-mm invasion in any one focus. Standard-of-care lung cancer staging ideally should be performed in a multidisciplinary meeting using the information provided both from CT and FDG-PET/CT with further inputs from the histopathologic findings (pathological staging). The seventh edition of the TNM classification for lung cancer emphasized the prognostic impact of the tumor size and subclassified T descriptors according to the tumor size. (2017) CA: a cancer journal for clinicians. 67 (2): 93-99. doi:10.3322/caac.21388 - Pubmed, differential diagnoses of airspace opacification, presence of non-lepidic patterns such as acinar, papillary, solid, or micropapillary, myofibroblastic stroma associated with invasive tumor cells. acute unilateral airspace opacification (differential), acute bilateral airspace opacification (differential), acute airspace opacification with lymphadenopathy (differential), chronic unilateral airspace opacification (differential), chronic bilateral airspace opacification (differential), osteophyte induced adjacent pulmonary atelectasis and fibrosis, pediatric chest x-ray in the exam setting, normal chest x-ray appearance of the diaphragm, posterior tracheal stripe/tracheo-esophageal stripe, obliteration of the retrosternal airspace, leflunomide-induced acute interstitial pneumonia, fibrotic non-specific interstitial pneumonia, cellular non-specific interstitial pneumonia, respiratory bronchiolitis–associated interstitial lung disease, diagnostic HRCT criteria for UIP pattern - ATS/ERS/JRS/ALAT (2011), diagnostic HRCT criteria for UIP pattern - Fleischner society guideline (2018)​, domestically acquired particulate lung disease, lepidic predominant adenocarcinoma (formerly non-mucinous BAC), micropapillary predominant adenocarcinoma, invasive mucinous adenocarcinoma (formerly mucinous BAC), lung cancer associated with cystic airspaces, primary sarcomatoid carcinoma of the lung, large cell neuroendocrine cell carcinoma of the lung, squamous cell carcinoma in situ (CIS) of lung, minimally invasive adenocarcinoma of the lung, diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH), calcifying fibrous pseudotumor of the lung, IASLC (International Association for the Study of Lung Cancer) 8th edition (current), IASLC (International Association for the Study of Lung Cancer) 7th edition (superseeded), 1996 AJCC-UICC Regional Lymph Node Classification for Lung Cancer Staging, tumor has an invasive component measuring 5 mm or less at histopathology, involves the main bronchus regardless of distance from the, chest wall (including the parietal pleura and, a single extrathoracic metastasis has a better survival and different treatment choices, which is why it has now been staged separately, TNM equivalent: any T, any N with M1a/M1b. A variety of alterations in this scheme have been made to better group patients with similar prognosis and treatment options. NB: The MX category is no longer used, it was removed in the 6th edition of the TNM system, if presence of metastases is not known the cancer is assigned M0 5. Erosion of a posterior right rib, T4 large-cell lung cancer. {"url":"/signup-modal-props.json?lang=us\u0026email="}. FDG PET/CT has a higher diagnostic value for the diagnosis of bone metastases compared to other methods. 3. Recent analyses of T staging using advanced MRI protocols showed that diagnostic accuracies of MRI were 82% to 94.3%, which were comparable to those of PET-CT (86%–91.4%). This has changed since 2013, with the IASLC staging now applying for both types of tumour. Chest wall invasion can be diagnosed confidently only when tumor obliterates the fat planes between parietal pleura and chest wall muscle or when there is associated bone destruction ( Figs. The revision of the lung cancer staging system is being overseen by the International Association for the Study of Lung Cancer. 18.4 ). Small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) used to be staged differently, with this staging system initially proposed only for NSCLC. Lung cancer staging has traditionally relied on a TNM staging system, for which the International Association for the … It has been shown to be more useful than CT alone in determining the T stage of the primary tumor and in assessing chest wall invasion. TNM Staging of Lung Cancer By Brendon Stiles, MD. Similar to CT, the main limitation of MRI is the inability to distinguish tumor invasion of mediastinal fat from inflammatory changes. 1st. 18.1 and 18.2 ). Radiology 1999; 212:803-809. Our dedicated team of physicians and staff offer a personalized, comprehensive Low Dose Lung Cancer Screening (LCS) program that can detect lung cancer in its earliest stages. 4. Moreover, increased spatial resolution can be obtained using parallel acquisition and reconstruction techniques: sensitivity encoding (SENSE) and simultaneous acquisition of spatial harmonics (SMASH). Tumour describes the size of the tumour (area of cancer). Lymph node involvement in lung cancer is categorized according to the location of the metastatic lymph nodes as N0 (no nodes involved), N1 (ipsilateral peribronchial, interlobar, or hilar node involvement), N2 (ipsilateral mediastinal or subcarinal node involvement), or N3 (contralateral mediastinal, contralateral hilar, or supraclavicular node involvement), regardless of the number of involved lymph nodes. Related links. Abstract. Lung Cancer. Abstract: Lung cancer is a common disease and the leading cause of cancer-related mortality, with non-small cell lung cancer (NSCLC) accounting for the majority of cases. J Thorac Oncol . The stages of lung cancer are indicated by Roman numerals that range from 0 to IV, with the lowest stages indicating cancer that is limited to the lung. According to a report, although statistically not significant ( P =.25), integrated PET-CT accurately staged the primary tumor (T stage) in 86% (91 of 106) of patients, whereas CT accurately staged the primary tumor in only 79% (84 of 106) of patients. Recently, the IASLC had collected new data of 77,156 patients diagnosed with lung cancer from 1999 to 2010. The International Association for the Study of Lung Cancer (IASLC) lymph node map, including the grouping of lymph node stations into “zones” for the purpose of prognostic analyses. (2017) Chest. Recently introduced MRI techniques using fast (T2W half-Fourier acquisition single-shot turbo-spin-echo (HASTE), and T1W fat-saturated three-dimensional gradient-echo sequences with nearly isotropic resolution) and high-quality (breath-hold, electrocardiogram-gated, black-blood techniques on T2W turbo-spin-echo [TSE] and short-T1 inversion recovery [STIR] sequences) scan parameters have greatly improved the image quality and the potential role of MRI in the staging of lung cancer ( Figs. It is recommended that solid and non-solid lesions should be measured on the image that shows the greatest tumor dimension (on axial, coronal, or sagittal planes). The radiograph also provides information about the T staging by demonstrating the size of the lesion in patients in whom it is circumscribed and the degree of associated atelectasis or obstructive pneumonitis in the presence of airway obstruction in patients in whom it is not circumscribed. In a few patients, however, multiple microscopical examinations of pleural (pericardial) fluid are negative for tumor, and the fluid is nonbloody and is not an exudate. Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE, Nicholson AG, Groome P, Mitchell A, Bolejack V. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. Publicationdate 2017-12-09. Unable to process the form. 18.5 and 18.6 ). The Eighth Edition Lung Cancer Stage Classification. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR, Winchester DP. Cancer staging, which defines the extent of disease, is crucial in guiding treatment and determining prognosis. The revision in the seventh edition consisted of changes in the T descriptors that emphasized the prognostic impact of tumor size and redefined the classification of additional tumor nodules and malignant pleural effusion, the subclassification of M1, the validation of the classification for bronchopulmonary carcinoid tumors, and the rearrangement of stage grouping, whereas the N descriptors remained the same. Also, the solid component of subsolid lesions should be performed on a lung or intermediate window rather than mediastinal window 3. Lung cancer staging is a validated tool that involves careful identification of the tumor, lymph node involvement, and metastatic spread. Lung carcinomas are likely to be extensively invasive and unresectable (T4) if they involve the tracheal carina or surround, encase, or abut more than 180 degrees of the circumference of the aorta ( Fig. Small cell lung cancer (SCLC), also known as oat cell lung cancer, is a subtype of bronchogenic carcinoma separated from non-small-cell lung cancer (NSCLC) as it has a unique presentation, imaging appearances, treatment, and prognosis. This article reviews regional lymph node assessment in lung cancer. 151 (1): 193-203. 8 Marom EM, McAdams PH, Erasmus JJ, et al. With recent advances in technology, it is important to update and standardize the radiological practices in lung … Revisions in the International System for Staging Lung Cancer. Die damals von der IASLC vorgeschlagenen Änderungen wurden sowohl von der UICC als auch von der AJCC vollständig übernommen. Lung cancer staging is based on the American Joint Committee for Cancer (AJCC) TNM (tumor, node, and metastases) system, which describes the greatest anatomic extent of disease (Table 1). FDG uptake higher than the blood pool is suspicious, and uptake higher than the liver it is highly concerning for nodal metastases. Guidelines are constantly being reviewed as more data becomes available to provide the most accurate prognostic markers, hence aiding in the clinical detection and staging of lung cancer. Diagnosis and clinical staging of lung cancer are fundamental to planning therapy. Previously, small cell lung cancer (SCLC) was not staged in the same manner as non-small cell lung cancer (NSCLC), but since 2013 both are staged using the IASLC (International Association for the Study of Lung Cancer) lung cancer staging system (currently in its 8th edition, published in 2016). The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. Rectal Cancer MR staging; Perianal Fistulas; Dynamic Rectal examination; Ultrasound. However, with regard to pathologic staging, the survival curves for N1 at multiple stations and N2 at a single station with N1 involvement overlapped each other, and N2 at a single station without N1 involvement had a better prognosis than N1 at multiple stations, although the difference was not significant. A variety of techniques can be used to investigate T, N, and M parameters to determine the appropriate tumor stage. The most widely used scheme for staging non–small cell lung cancer (NSCLC) is the TNM classification. 18.7 and Table 18.4 ) is the IASLC nodal map and anatomic definitions, and it is still the recommended means of describing regional lymph node involvement for lung cancers in the proposed eighth edition. 5. Reprints: John F Bruzzi, FFRRCSI, Department of Radiology, MD Anderson Cancer Center, 1515 Holcombe Boulevard—Unit 57, Houston, TX 77030-4009 (e-mail: jbruzzi@mdanderson.org). ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Volume 11, Number 1 . Endobronchial biopsy of an FDG-avid node is recommended to confirm the highest pathologic stage of disease 4. TX: Tumour cannot be assessed (or is not visualized) T0: There is no evidence of a primary tumour: Tis: Carcinoma in situ: T1: A tumour measuring < 3cm (greatest dimension) it is surrounded by lung or visceral pleura there is no bronchoscopic evidence of invasion within the main bronchus T1a Kandathil A, Kay FU, Butt YM, Wachsmann JW, Subramaniam RM. Introduction. Although lung cancer was one of the earliest indications for PET imaging, the vast majority of data has been obtained on NSCLC. Heart, great vessels, or vertebral body invasion in Pancoast tumors distinguish tumor of... 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