CONTENTS:

2.10 Advanced Lung Cancer Imaging for Stage III or IV Disease
2.11 Imaging the Pleura

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‘Anything you say will be taken down..’ said the policewoman. ‘Knickers’ I shouted. My court case is on Friday!

2.10 Advanced Lung Cancer Imaging for Stage III to IV Disease

 
Patients with clinically advanced lung cancer or staging systems lung cancer should have imaging of the brain with magnetic resonance imaging (MRI) or CT. MRI of the brain for the early detection of brain metastases allows for early treatment.

There is as yet no supporting evidence that PET is useful in identifying occult lung cancer metastases in patients with clinical stage IA Non-Small Cell Lung Cancer (SCLC).

Repeat imaging may be required during lung cancer staging and evaluation or when new symptoms occur.  Furthermore,  if there is a significant delay before starting therapy repeat imaging may be necessary.  However, There is no standard optimal timing for repeat imaging it all depends on each individual case.

Bone scintigraphy may be used when PET or PET/CT are not available. However, bone scintigraphy has a high ‘false-positive’ possibly due to degenerative bone disease. For the diagnosis of bone metastases, MRI has comparable accuracy to bone scintigraphy.

A bunch of satanic, occult worshippers have just moved in next door to me….talk about the neighbours from hell!

2.11 Imaging the Pleura

 
Lung cancer may involve the pleura by direct invasion or via metastases. There are also primary tumors of the pleura, most importantly, mesothelioma. However, mesothelioma has a characteristic appearance.

Evaluation of pleural disease may require several imaging methods (PET, CT, ultrasound, and / or MRI) as well as invasive biopsy procedures (thoracentesis, thoracoscopy, or pleural biopsy).

CT imaging is particularly important in evaluating lung cancer with direct extension into parietal pleura, visceral pleura or extra-pleural fat.  These T2/3 tumors, they are usually operable and should be distinguished from metastatic involvement of the pleural space (M1a), which is inoperable.

Some retrospective clinical studies have shown PET to be an accurate imaging technique in the detection of pleural metastases from lung cancer.

What does that mean?

Well if a primary lung tumour has extended into the pleura and is under a certain size than it is often operable. If it is a cancer that has spread to the pleura from another place it is not operable.

That’s an important distinction then.

Furthermore, an ultrasound scan can assess the pleural space. Some clinical imaging studies have shown that the sensitivity of ultrasound is comparable to CT.   Pleural thickening > 1 cm, pleural nodularity, and diaphragmatic thickening > 7 mm were shown to be indicative of metastatic pleural disease.

MRI may be useful when evaluating the extent of tumor invasion through muscle, nerve, and bone but has not been formally studied as a staging method for pleural involvement in lung cancer.

Remember, don’t sweat the petty things and don’t pet the sweaty things.

References:

Bénard F, Sterman D, Smith RJ, Kaiser LR, Albelda SM, Alavi A. (1999) Prognostic value of FDG PET imaging in malignant pleural mesothelioma. Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine [1999, 40(8):1241-1245] (Retrieved 10^th April 2015): http://europepmc.org/abstract/med/10450672

Yokoi K, Kamiya N, Matsuguma H, Machida S. et al. (1999) Detection of Brain Metastasis in Potentially Operable Non-small Cell Lung Cancer: A Comparison of CT and MRI. Chest. 1999;115(3):714-719 (Retrieved 10^th April 2015): https://www.ncbi.nlm.nih.gov/pubmed/10084481

More references for this section are on this page.

Patient Information:

Centers for Disease Control and Prevention (CDC). Lung Cancer. Information on Lung Cancer Screening. (Retrieved 22^nd Jan 2015): http://www.cdc.gov/cancer/lung/basic_info/screening.htm

Lung Health UK. Information on lung cancer tests and diagnosis. (Retrieved 22^nd Jan 2015): https://www.lunghealthuk.com

More patient information for this section is on this page.

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