Nodal staging of NSCLC: A pictorial atlas of thoracic lymph node stations utilizing FDG PET/CT

Abstract

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Learning Objectives: 1. Learn the anatomy of thoracic nodal stations through review of FDG PET/CT images. 2. Review the AJCC nodal staging guidelines for non-small-cell lung cancer. 3. Learn the benefits of FDG PET/CT over conventional CT in nodal staging.

Abstract Body: The initial staging of non-small-cell lung cancer has significant prognostic and therapeutic implications. Both CT and FDG PET/CT are currently used in the initial workup of NSCLC. While CT alone is adequate for tumor (T) staging, the added value that FDG PET/CT provides has been clearly demonstrated in the assessment of regional lymph node involvement (N) and in detecting distant metastases (M). The presence of malignant lymph nodes in the mediastinum can significantly alter management and prognosis, and so, their detection and accurate localization is highly important in a staging workup. A thorough knowledge of the anatomic locations of thoracic lymph nodes is critical for the physician interpreting an FDG PET/CT study performed for NSCLC staging. The location of a node can alter the stage and prognosis, determine a patient’s surgical candidacy, and also help the clinician determine the best possible route for lymph node biopsy. We present a pictorial atlas of the thoracic lymph node stations utilizing images from FDG PET/CT studies to help simplify the anatomy of thoracic lymphadenopathy. Learning the anatomic locations of the thoracic lymph node stations as outlined by the American Joint Committee on Cancer will lead to more consistent reporting of PET/CT studies between readers and will allow the interpreting physician to communicate more effectively with referring oncologists, pulmonologists, and thoracic surgeons.