- Email: [email protected]
The Future of Fibroid Therapy: New Competing Procedures vs. UAE
by occlusion of uteroovarian collateral vessels before UAE. ]VIR 2003; 14: 1329-1332.
Staging and Current Imaging of Lung Cancer Gerald F. Abbott, MD Brown Medical School Rhode Island Hospital ProVidence, RI Thoracic imaging plays a pivotal role in the detection, diagnosis, and staging of lung cancer and is also useful in assessing response to therapy and monitoring for tumor recurrence. This presentation will review the characteristic imaging features and the staging of non-small cell lung cancer (NSCLC) and emphasize the role of computed tomography (CT) and positron emission tomography (PET) in patient management.
cally central tumors and may be associated with distal atelectasis and pneumonitis. NSCLC may manifest on imaging studies as a solitary peripheral pulmonary nodule or mass with variable border characteristics (ill defined, spiculated or well defined lobular contours) or as a central mass, with or without secondary atelectasis, obstructive pneumonia and/or mucoid impaction. The imaging manifestations distal to a central obstructing lesion may be the dominant radiologic abnormality and obscure the causative tumor. Cavitation occurs in up to 15% of lung cancers; calcification, which is usually stippled and eccentric, occurs in up to 10%. Lymphadenopathy may manifest as direct extension from the primary tumor or as regional involvement of ipsilateral or contralateral hilar or mediastinal lymph nodes. Mediastinal, osseous or soft tissue invasion may be found in advanced stages of lung cancer. Pleural effusion, pleural masses, or both suggest pleural involvement. Bronchioloalveolar carcinoma (BAC) is a subtype of adenocarcinoma with distinctive morphologic and prognostic features. It represents approximately 5% of lung cancers and most commonly manifests as a peripheral solitary pulmonary nodule of heterogeneous attenuation including ground glass attenuation, air bronchograms / bronchiolograms and intratumoral "bubble-like" cystic air spaces. Less frequently, BAC manifests as focal consolidation or as multifocal nodules, masses and / or consolidations and may mimic pneumonia. BAC demonstrates less FDG activity than other cell types of lung cancer and may result in a false negative PET scan. The radiographic "S-sign of Golden" refers to lobar collapse associated with a central obstructing mass. It was originally described with reference to right upper lobe collapse. The "S" refers to the combination of a concavity (produced by elevation of the minor fissure during right upper lobe collapse) and a convexity (produced by a bulging mass at the right hilum). Similar contour abnormalities may be seen involving other lobes. Magnetic resonance (MR) imaging is more sensitive than CT for demonstration of chest wall involvement and may also be useful in the demonstrating hilar and/or mediastinal lymphadenopathy, particularly if a patient has a contraindication for the intravenous administration of iodinated contrast material. PET is a non-invasive modality for the evaluation of patients with lung cancer. Imaging is performed after intravenous administration of 2-(fluorine-18)-fluoro-2deoxy-D-glucose (l8FDG). FDG is accumulated from increased glucose utilization by malignant cells. PET has a high sensitivity and negative predictive value in nodules over 1 cm in diameter.
Imaging Lung cancer has a variety of imaging manifestations, some of which are characteristic for its respective cell types. Adenocarcinomas, the most frequent cell type, are typically peripheral lesions, whereas squamous cell carcinomas (and small cell carcinomas) are characteristi-
Staging Staging of NSCLC is performed according to the International System for Staging Lung Cancer classification and is important for standardization in determining therapeutic management and prognosis of the disease. The parameters evaluated and designated within this system are
11. Andrews RT, Bromley PJ, Pfister ME. Successful embolization of collaterals from the ovarian artery during UAE for fibroids: A case report.]VIR 2000; 11: 607-610. 12. Barth MM, Spies JB. OA embolization supplementing uterine embolization for leiomyomata. JVIR 2003; 14: 1177-1182. 3:55 p.m. The Future of Fibroid Therapy: New Competing Procedures vs. UAE Gary P. Siskin, MD Albany Medical College Albany, NY 4:15 p.m. Maintenance of Certification (MOC) Anne C. Roberts, MD UCSD Medical Center/7bomton Hospital La jolla, CA
Organ Specific Oncologic Therapy-lung (CC) Coordinator / Moderator: Damian E. Dupuy, MD
Objectives: Upon completion of this course, the attendee should be able to: 1. Define current staging, imaging and treatment of lung cancer. 2. Describe the role of image-guided tumor ablation in patients with lung cancer. 3. Identify potential synergy of conventional treatment and image-guided tumor ablation. 4:45 p.rn..
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Staging and Current Imaging of Lung Cancer Gerald F. Abbott, MD Brown Medical School Rhode Island Hospital ProVidence, RI Thoracic imaging plays a pivotal role in the detection, diagnosis, and staging of lung cancer and is also useful in assessing response to therapy and monitoring for tumor recurrence. This presentation will review the characteristic imaging features and the staging of non-small cell lung cancer (NSCLC) and emphasize the role of computed tomography (CT) and positron emission tomography (PET) in patient management.
cally central tumors and may be associated with distal atelectasis and pneumonitis. NSCLC may manifest on imaging studies as a solitary peripheral pulmonary nodule or mass with variable border characteristics (ill defined, spiculated or well defined lobular contours) or as a central mass, with or without secondary atelectasis, obstructive pneumonia and/or mucoid impaction. The imaging manifestations distal to a central obstructing lesion may be the dominant radiologic abnormality and obscure the causative tumor. Cavitation occurs in up to 15% of lung cancers; calcification, which is usually stippled and eccentric, occurs in up to 10%. Lymphadenopathy may manifest as direct extension from the primary tumor or as regional involvement of ipsilateral or contralateral hilar or mediastinal lymph nodes. Mediastinal, osseous or soft tissue invasion may be found in advanced stages of lung cancer. Pleural effusion, pleural masses, or both suggest pleural involvement. Bronchioloalveolar carcinoma (BAC) is a subtype of adenocarcinoma with distinctive morphologic and prognostic features. It represents approximately 5% of lung cancers and most commonly manifests as a peripheral solitary pulmonary nodule of heterogeneous attenuation including ground glass attenuation, air bronchograms / bronchiolograms and intratumoral "bubble-like" cystic air spaces. Less frequently, BAC manifests as focal consolidation or as multifocal nodules, masses and / or consolidations and may mimic pneumonia. BAC demonstrates less FDG activity than other cell types of lung cancer and may result in a false negative PET scan. The radiographic "S-sign of Golden" refers to lobar collapse associated with a central obstructing mass. It was originally described with reference to right upper lobe collapse. The "S" refers to the combination of a concavity (produced by elevation of the minor fissure during right upper lobe collapse) and a convexity (produced by a bulging mass at the right hilum). Similar contour abnormalities may be seen involving other lobes. Magnetic resonance (MR) imaging is more sensitive than CT for demonstration of chest wall involvement and may also be useful in the demonstrating hilar and/or mediastinal lymphadenopathy, particularly if a patient has a contraindication for the intravenous administration of iodinated contrast material. PET is a non-invasive modality for the evaluation of patients with lung cancer. Imaging is performed after intravenous administration of 2-(fluorine-18)-fluoro-2deoxy-D-glucose (l8FDG). FDG is accumulated from increased glucose utilization by malignant cells. PET has a high sensitivity and negative predictive value in nodules over 1 cm in diameter.
Imaging Lung cancer has a variety of imaging manifestations, some of which are characteristic for its respective cell types. Adenocarcinomas, the most frequent cell type, are typically peripheral lesions, whereas squamous cell carcinomas (and small cell carcinomas) are characteristi-
Staging Staging of NSCLC is performed according to the International System for Staging Lung Cancer classification and is important for standardization in determining therapeutic management and prognosis of the disease. The parameters evaluated and designated within this system are
11. Andrews RT, Bromley PJ, Pfister ME. Successful embolization of collaterals from the ovarian artery during UAE for fibroids: A case report.]VIR 2000; 11: 607-610. 12. Barth MM, Spies JB. OA embolization supplementing uterine embolization for leiomyomata. JVIR 2003; 14: 1177-1182. 3:55 p.m. The Future of Fibroid Therapy: New Competing Procedures vs. UAE Gary P. Siskin, MD Albany Medical College Albany, NY 4:15 p.m. Maintenance of Certification (MOC) Anne C. Roberts, MD UCSD Medical Center/7bomton Hospital La jolla, CA
Organ Specific Oncologic Therapy-lung (CC) Coordinator / Moderator: Damian E. Dupuy, MD
Objectives: Upon completion of this course, the attendee should be able to: 1. Define current staging, imaging and treatment of lung cancer. 2. Describe the role of image-guided tumor ablation in patients with lung cancer. 3. Identify potential synergy of conventional treatment and image-guided tumor ablation. 4:45 p.rn..
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