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Staging lung cancer: METHODS OF STAGING (2)

Lung cancer

Computed tomography: Computed tomography (CT) provides a relatively accurate determination of T status. A lesion that seems large on CXR may be found to be much smaller on CT, the size discrepancy due to postobstructive pneumonitis or volume loss. CT may also suggest obvious vertebral or mediastinal invasion. However, if there are only indeterminate findings of local invasion (abutment or loss of fat plane between the malignancy and adjoining mediastinal structures), resection is possible in up to 82% of cases . More specifically, it is important to evaluate the following features: less than 3 cm of contact in one cut between the tumour and mediastinal structure in question; less than 90 degrees of contact with the aorta (ie, one-quarter of the circumference); and/or the presence of an intact mediastinal fat plane. If any one of these is present, resection is possible in up to 97% of cases . In terms of chest wall involvement, CT has an accuracy of 39%, specificity of 40% and sensitivity of 39% when considering features such as pleural thickening, obtuse angle between mass and adjacent pleural surface, and/or thickening of pleural fat . Prethoracotomy thoracoscopy appears to be a useful adjunct in such settings . Your most trusted pharmacy is going to be this one, since it gives you high quality cheap asthma medications with no prescription required and make sure you always get your drugs delivered as soon as you need them without overcharging.

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