2009 Non-Small Cell Lung Cancer Staging System (3)

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As a radiologist, it may be easier to memorize "T" classification based on imaging appearance. The scheme below may be used as a guidance to stage these tumors, however a full text of the New Staging System should be reviewed for comprehensiveness.

1. Peripheral mass abutting chest wall or diaphragm --- see if there is evidence of invasion of chest wall or diaphragm (T3)
2. Peripheral mass, distal to lobar bronchus, completely surrounded by lung --- measuring size (less than 3cm = T1, 3-7cm = T2, more than 7cm = T3)
3. Mass distal to 2 cm from the carina but proximal to lobar bronchus --- T2 by definition
4. Endobronchial mass: distal to 2 cm from the carina = T2; within 2 cm from the carina = T3
5. Central mass with postobstructive pneumonitis or atelectasis: lobar or segmental = T2;entire lung = T3
6. Central mass abutting the mediastinum: invade mediastinal pleura, parietal pericardium = T3; diaphramatic paralysis (phrenic nerve involvement) = T3; invade heart, great vessels, trachea, esophagus, carina, vertebral body = T4
7. Additional malignant lung nodules: same lobe = T3; ipsilateral different lobe = T4; contralateral = M1a
8. Malignant pleural effusion or pleural nodule = M1a

Reference:

Detterbeck FC, Boffa DJ, Tanoue LT. The new lung cancer staging system. Chest 2009:136;260-271.

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