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Symposium St. Gallen 28 November 2013. Update on clincial staging. Christophe Dooms, MD, PhD.

Symposium St. Gallen 28 November 2013. Update on clincial staging. Christophe Dooms, MD, PhD. Respiratory Division University Hospitals Leuven Leuven Lung Cancer Group Belgium. Multidisciplinarity of staging. Precise TNM stage with pathological diagnosis and

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Symposium St. Gallen 28 November 2013. Update on clincial staging. Christophe Dooms, MD, PhD.

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  1. Symposium St. Gallen 28 November 2013. Update on clincial staging. Christophe Dooms, MD, PhD. Respiratory Division University Hospitals Leuven Leuven Lung Cancer Group Belgium.

  2. Multidisciplinarity of staging. Precise TNM stage with pathological diagnosis and technical feasibility should be available before treatment : • cT : mainly by CT scan and bronchoscopy • cN : mainly by endosonography and/or surgical techniques • cM : mainly by integrated PET/CT and MRI/CT brain • Pathological procedures : - frequently small diagnostic biopsies - molecular testing on small tissue samples • Technical : Resectability ? Concurrent CRT ?

  3. Role of PET in diagnosis of SPN. Ost and Gould. AJRCCM 2012;185:363.

  4. Management algorithm for SPN. Patel V, et al. Chest 2013;143:840.

  5. Management algorithm for SPN. Patel V, et al. Chest 2013;143:840.

  6. Lung cancer staging : T-factor. • Bronchoscopy • Extension : T2 ifmainbronchus >2cm • T3 ifmainbronchus <2cm • T4 trachea • Resectability : (sleeve)lobectomy / pneumonectomy • Detection of synchronous radio-occult disease

  7. Mediastinal nodal staging. noconfirmationneeded ASTER EUS-FNA – EBUS-TBNA combined WCLC 2013 : EBUS or EUS centered ? Or is EBUS and EUS-B goodenough ?

  8. Mediastinal nodal staging. Studies of complete endosonography

  9. Impact of PET on treatment selection

  10. Impact of PET on treatment selection Fischer et al. NEJM 2009;361:32. Maziak et al. Ann Intern Med 2009;151:221. Ung et al. J Clin Oncol 2009;27:15s(7548). Yi et al. Cancer 2013;119:1784-91.

  11. Conclusion : staging algorithm. • CE integrated PET-CT + MRI/CT brain • PET justified to detect unsuspected extrathoracic disease • PET has the abitity to direct invasive technique if clinical M1 clinical M1a clinical M1b Thoracocentesis ? Pericardiocentesis ? Thoracoscopy ? solitary multiple Stage IV disease ? Stage IV ? Stage IV !

  12. Conclusion : staging algorithm. • CE integrated PET-CT + MRI/CT brain • PET justified to detect unsuspected extrathoracic disease (verification!) • PET has the abitity to direct invasive technique (endosonography) if clinical M0 * MLNs 10mm * any PET+ MLN if normal mediastinum but * central cT3/4 cN0 * cT1-3 cN1 combined E(B)US-FNA Surgical staging Proven N2/3 No N2/3 Multimodal therapy

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