肺癌分期PET医学课件.ppt
肺癌新分期的影像学表现及PET/CT在分期中的价值和挑战,1,目 的,1997年TNM分期改动介绍,a.胸壁侵犯(T3),b.同侧及对侧(N3),c.范围(N2 vs.N3,M1),什么原因产生了这些变化？（新统计数据）,a.没有特异性,缺陷,b.实用性问题,c.不可预期情况,2,非小细胞肺癌,1997早期标准,原发灶(T1,T2,T3,T4),区域淋巴结(N0,N1,N2,N3),远处转移(M0,M1),3,修订后标准,（国际肺癌研究协会）,T1,a 2cm,b 2cm to 3cm,T2,a 3cm to 5cm,b 5cm to 7cm,T3,7cm,原发灶同一肺叶出现卫星结节,T4,同侧不同肺叶出现卫星结节,Rami Porta et al.The IASLC Lung Cancer Staging Project:Proposals for the Revision,of the T descriptors in the Forthcoming(Seventh)Edition of the TNM Classification,for Lung Cancer.J Thorac Oncol 2007;2:593-602,4,非小细胞肺癌,TNM 分期,T1-早期标准,原发灶 3 cm,周围被肺及脏层胸膜包绕,气管镜下侵犯没有超出叶支气管,T1-新标准,a 2cm,b 2cm to 3cm,5,T1,T1a,2cm,6,修订后标准,（国际肺癌研究协会）,T1,a 2cm,b 2cm to 3cm,T2,a 3cm to 5cm,b 5cm to 7cm,T3,7cm,原发灶同一肺叶出现卫星结节,T4,同侧不同肺叶出现卫星结节,Rami Porta et al.The IASLC Lung Cancer Staging Project:Proposals for the Revision,of the T descriptors in the Forthcoming(Seventh)Edition of the TNM Classification,for Lung Cancer.J Thorac Oncol 2007;2:593-602,7,非小细胞肺癌,TNM 分期,T2 早期标准,原发灶 3 cm,主支气管侵犯，但距隆突2cm,肺不张或阻塞性肺炎少于一侧肺,侵犯脏层胸膜,T2 新标准,a 3cm to 5cm,b 5cm to 7cm,8,T2,T2a,3cm to 5cm,9,修订后标准,（国际肺癌研究协会）,T1,a 2cm,b 2cm to 3cm,T2,a 3cm to 5cm,b 5cm to 7cm,T3,7cm,原发灶同一肺叶出现卫星结节,T4,同侧不同肺叶出现卫星结节,Rami Porta et al.The IASLC Lung Cancer Staging Project:Proposals for the Revision,of the T descriptors in the Forthcoming(Seventh)Edition of the TNM Classification,for Lung Cancer.J Thorac Oncol 2007;2:593-602,10,T2,T2b,?,5cm to 7cm,测量误差？,11,T2,T3,7cm,12,修订后标准,（国际肺癌研究协会）,T1,a 2cm,b 2cm to 3cm,T2,a 3cm to 5cm,b 5cm to 7cm,T3,7cm,原发灶同一肺叶出现卫星结节,T4,同侧不同肺叶出现卫星结节,Rami Porta et al.The IASLC Lung Cancer Staging Project:Proposals for the Revision,of the T descriptors in the Forthcoming(Seventh)Edition of the TNM Classification,for Lung Cancer.J Thorac Oncol 2007;2:593-602,13,非小细胞肺癌,TNM 分期,T2,(其它标准),主支气管侵犯，但距隆突2cm,肺不张或阻塞性肺炎少于一侧肺,侵犯脏层胸膜,14,T2,阻塞性肺炎少于一侧肺,距隆突 2cm,15,T2,侵犯脏层胸膜（手术证实）,16,非小细胞肺癌,TNM 分期,T3(其它标准),全肺不张或阻塞性肺炎,胸壁侵犯,距离隆突2cm，但未及隆突,侵犯纵隔胸膜、膈神经或心包,17,T3,全肺不张,18,T3,均侵犯胸壁,与大小无关（箭头）,(哪一个侵犯了纵隔?),19,非小细胞肺癌,TNM 分期,T4-早期标准,侵犯椎体，大气管、食管、纵隔、隆突等,同侧不同肺叶出现卫星结节,恶性积液,20,T4,椎体侵犯,21,T4,MRI,侵入左心房,(不仅通过纵隔胸膜),22,T4,CT,侵犯左心房,(与原发灶大小无关-见箭头),23,非小细胞肺癌,TNM 分期,T4-早期标准,侵犯椎体，大气管、食管、纵隔、隆突等,同侧不同肺叶出现卫星结节,恶性积液,24,T4,M1a,恶性积液,(胸腔或心包),25,非小细胞肺癌,TNM 分期,T4-早期标准,侵犯椎体，大气管、食管、纵隔、隆突等,同侧不同肺叶出现卫星结节,恶性积液,26,T4,T3,同侧肺叶结节,27,修订后标准,（国际肺癌研究协会）,T1,a 2cm,b 2cm to 3cm,T2,a 3cm to 5cm,b 5cm to 7cm,T3,7cm,原发灶同一肺叶出现卫星结节,T4,同侧不同肺叶出现卫星结节,Rami Porta et al.The IASLC Lung Cancer Staging Project:Proposals for the Revision,of the T descriptors in the Forthcoming(Seventh)Edition of the TNM Classification,for Lung Cancer.J Thorac Oncol 2007;2:593-602,28,T4,T3,T4?(同一肺叶还是不同肺叶？),29,NSCLC 分期,区域淋巴结情况,N0,无区域淋巴结转移,N1,同侧支气管或肺门淋巴结转移,N2,同侧纵隔和/或隆突下淋巴结转移,N3,对侧纵隔和/或对侧肺门，和/或同侧或对侧前斜角肌或锁骨上淋巴结转移,30,淋巴结分布,31,Radiologists may report TNM status but not usually actual stage as it may change with,further analysis(e.g.,with biopsy/surgery pathology),32,PET/CT 在分期中的价值,肺癌,左锁骨上淋巴结转移,IIIb 期(任何 T,N3),CT箭头所示,33,?N2-Malignant vs.benign lymph node,良性还是恶性?,活检证实为感染所致炎症性摄取（箭头）,并非所有FDG高代谢均为恶性！,34,NSCLC 分期,远处转移情况,早期标准,M0,无远处转移,M1,有远处转移,非原发灶所在肺叶出现卫星结节,35,修订后标准,M1a,恶性胸腔或心包积液,恶性胸膜结节,对侧肺内转移结节,M1b,远处转移,Postmus P et al.The IASLC Lung Cancer Staging Project:Proposals for the,Revision of the M descriptors in the Forthcoming(Seventh)Edition of the TNM,Classification for Lung Cancer:J Thorac Oncol 2007;2:686-693,36,T4,M1a,恶性积液,(胸腔或心包),37,修订后标准,M1a,恶性胸腔或心包积液,恶性胸膜结节,对侧肺内转移结节,M1b,远处转移,Postmus P et al.The IASLC Lung Cancer Staging Project:Proposals for the,Revision of the M descriptors in the Forthcoming(Seventh)Edition of the TNM,Classification for Lung Cancer:J Thorac Oncol 2007;2:686-693,38,肺癌 M1,M1a,对侧肺内结节,(转移还是原发？),39,PET/CT诊断远处转移的价值,左侧肾上腺无放射性异常摄取（箭头）,肺癌,40,Adrenal M1,M1b,PET/CT冠状位成像,CT示左侧肾上腺侵犯(箭头),左侧肾上腺转移(箭头),41,肾上腺 M1,M1b,肺 癌,42,肾上腺 M1,M1b,肺 癌,正常大小的肾上腺转移（箭头）,43,脑 M1,M1b,44,骨 M1,M1b,肺癌(长箭头)骨转移(短箭头),45,Radiologists may report TNM status but not usually actual stage as it may change with,further analysis(e.g.,with biopsy/surgery pathology),46,肺 癌,小 结,1,TNM分期可以指导制订诊疗计划,而分期的不断修改能使诊疗更加规范,2,CT 是诊断原发肿瘤的经典手段,3,PET/CT 对淋巴结及远处转移有较高价值,47,没有一成不变的征象，只有发现问题的慧眼！,48,
