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Congress: ECR25
Poster Number: C-21962
Type: Poster: EPOS Radiologist (educational)
Authorblock: A-M. Zugravu-Herciu, C. Amalia, D. Manolescu; Timisoara/RO
Disclosures:
Ana-Maria Zugravu-Herciu: Nothing to disclose
Constantinescu Amalia: Nothing to disclose
Diana Manolescu: Nothing to disclose
Keywords: Lung, Oncology, Respiratory system, CT-High Resolution, PACS, Ultrasound, Biopsy, Contrast agent-intravenous, Staging, Cancer, Chronic obstructive airways disease, Outcomes
Findings and procedure details

The updates brought by the ninth TNM edition are as follows:

T descriptor

The new edition has validated the descriptors introduced by the previous edition that pertain to the characteristics of the primary tumor, hence no additions were made with regard to the T category.

 

N descriptor

The N2 category, which implies metastatic disease affecting the ipsilateral mediastinal and/or subcarinal nodal stations, has been split into:

N2a – involvement of a single N2 station;

N2b – involvement of multiple N2 stations.

In the ninth TNM edition, it is worth noting that nodal disease is measured by the number of the involved nodal stations, rather than the total number of lymph nodes affected. 

 

M descriptor

The M1c subcategory has been divided into its component parts:

M1c1 -  multiple metastatic deposits affecting a single extrathoracic organ;

M1c2 -  multiple metastatic deposits affecting multiple extrathoracic organs.

 

Stage groups

Taking into account the aforementioned revisions, a more precise stratification of lung cancers has been implemented by reordering the TNM combinations encompassing certain stage groups:

  • T1N1 tumors: downstaged from IIB to IIA;
  • T1N2a tumors: downstaged from IIIA to IIB;
  • T2N2b tumors: upstaged from IIIA to IIIB;
  • T3N2a tumors: downstaged from IIIB to IIIA.

Nonetheless, stage IV was not affected by these rearrangements, due to the fact that M1c1 and M1c2 have both been assigned to stage IVB, consistent with the M1 classification of the previous edition.

 

The downstaging draws special attention to the expanded treatment options available for patients presenting with lung cancer, even in cases that were previously regarded as too advanced for surgical resection.

For example, the treatment options for stage IIIA NSCLC include a combination of surgery, chemotherapy, radiation therapy, immunotherapy, as well as targeted therapies. In contrast, stage IIIB NSCLC is frequently deemed unsuitable for surgical intervention, and treatment options typically revolve around chemotherapy and radiation therapy. Therefore, T3N2a NSCLC tumors, having been downstaged from IIIB to IIIA, could now be amenable to surgical intervention, in addition to the previously mentioned non-surgical treatments.
GALLERY