1 / 26

Approaching to clinically T4 tumours

Approaching to clinically T4 tumours. Dr Murat Kıyık. AJCC/UICC 1997 :STAGING T4. Mediastinal invasion Great vessel invasion Cardiac invasion Tracheal inv. Carinal inv. Eosophageal inv. Vertebral body inv. Malign Pleural effusion Malign Pericardial effusion

lewis
Télécharger la présentation

Approaching to clinically T4 tumours

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Approaching to clinically T4 tumours Dr Murat Kıyık

  2. AJCC/UICC 1997 :STAGINGT4 • Mediastinal invasion • Great vessel invasion • Cardiac invasion • Tracheal inv. • Carinal inv. • Eosophageal inv. • Vertebral body inv. • Malign Pleural effusion • Malign Pericardial effusion • Satellit nodules in the same lobe with primary tumour

  3. Symptoms and signs • Chest pain • Wheezing and stridor • Dysphagia • Hoarseness • Superior venae cava syndrom • Pleural effusion • Pericardial effusion

  4. J Thorac Oncol 2007;2:593-602

  5. REVISION OF T4 : IASLC 2007 • Mediastinal invasion • Great vessel invasion • Cardiac invasion • Tracheal inv. • Carinal inv. • Eosophageal inv. • Vertebral body inv. • Malign Pleural effusion • Malign Pericardial effusion • Satellit nodules in the same lobe with primary tumour Rami-Porta R. et al.J Thorac Oncol 2007;2:593-602

  6. Satellite Nodules in the same lobe P=0.28 T4 T3

  7. Unilateral Satellite Nodules in different lobes p=0.41 M1T4

  8. Malign Pleural Effusion p=0.0001 T4 M1

  9. Frequency of T4 ( N0-3M0) Rami-Porta R. et al.J Thorac Oncol 2007;2:593-602

  10. Frequency of T4 (N0M0) Rami-Porta R. et al.J Thorac Oncol 2007;2:593-602

  11. Techniques in staging of T4 • Noninvasive/Radiological • Chest X ray • Thorax CT • Thorax MRI • PET • Minimally invasive • FOB • Laryngeal examination • Tracheal/Carinal byopsy • Thorasynthesis/Pleural byopsy • TEE (transeosophageal echocardiography) • Invasive • Mediastinotomy • VATS • Thorachotomy

  12. Resectability evaluation : CT Glazer HS et al Radiology 1989

  13. CT findings of mediastinal invasion Herman SJ et al. Radiology 1994

  14. Exclusion of mediastinal invasion with CT findings • 3 cm mediastinal contact of mass • Prevention of fatty plan • < 90° aortical contact of mass

  15. Mediastinal invasion criteria with Thorax CT • 180° mediastinal contact of mass • presence of intraluminal tumour in mediastinal structures

  16. Mediastinal InvasionThorax CT  MRI • *Radiology 1991 • **MAGMA 1996 • ***ERS Kongresi 2006

  17. 36 years-old male

  18. Difficulties in evaluating mediastinal invasion with CT and MRI • Motion artefacts • Fibrosis • Reactive inflammatory changes • Athelectasies • Obstructive pneumonaie

  19. TEE to evaluate aortical invasion Schröder C.et al Chest 2005;127:438-442

  20. pT4 (12 cases) TEEThorax CT

  21. THANK YOU…

More Related