Lung Cancer CT Scan Reporting

A lung cancer CT scan report is a systematic diagnostic report observed on a CT images to detect lung cancer or identifies potential abnormalities like nodules, masses, or enlarged lymph nodes. This report details the anatomical findings observed in the area under evaluation. It translates these findings into clinically significant information and recommendations for further treatment.

Purpose

I. Non–Small Cell Lung Carcinoma (NSCLC)

1. Adenocarcinoma

Solid adenocarcinoma

Lepidic adenocarcinoma

Acinar adenocarcinoma

Papillary adenocarcinoma

Micropapillary adenocarcinoma

Mucinous adenocarcinoma

Adenocarcinoma in situ (AIS)

Minimally invasive adenocarcinoma (MIA)

2. Squamous Cell Carcinoma

Central squamous cell carcinoma

Cavitating squamous cell carcinoma

Endobronchial squamous carcinoma

3. Large Cell Carcinoma

Undifferentiated large cell carcinoma

Large cell neuroendocrine carcinoma

II. Small Cell Lung Carcinoma (SCLC)

Central small cell carcinoma

Perihilar small cell carcinoma

Diffuse infiltrative small cell carcinoma.

III. Neuroendocrine Tumors of the Lung

1.Typical Carcinoid Tumor

2.Atypical Carcinoid Tumor

3.Large Cell Neuroendocrine Carcinoma

4.Small Cell Neuroendocrine Carcinoma

V. Secondary Lung Malignancies (Detected on CT)

Hematogenous metastases

Lymphangitic carcinomatosis

Endobronchial metastases

VI. Pre-Invasive and Early Lung Cancer Lesions (CT-Detectable)

Atypical adenomatous hyperplasia

Adenocarcinoma in situ

Minimally invasive adenocarcinoma

VII. Lung Cancers by Location (CT-Based Classification)

1.Central Lung Cancers

Squamous cell carcinoma

Small cell carcinoma

Carcinoid tumors

2.Peripheral Lung Cancers

Adenocarcinoma

Large cell carcinoma

Metastatic nodules

Patient Details & Clinical Information

Patient identification details

These include components like patient name, age, sex, patient ID or registration number, date of examination, and referring physician or department. These details serve the administrative and compliance purposes.

Clinical history

The clinical history includes detailed medical information about the patient’s condition, such as signs and symptoms, duration of the symptoms, previous clinical history, ongoing medication, etc.

Indications for a CT scan

The indications refer to the suspected condition the patient might be suffering from, based on the clinical history. E.g., suspected lung malignancy, evaluation of masses or nodules, staging of the cancer, etc.

Imaging technique details

After an imaging modality is selected (in this case, a CT scan), details regarding these modalities must be presented in the report. These details include the type of CT scan, contrast use, scan coverage, slice thickness, and reconstruction planes.

Findings observed

This section encompasses any abnormalities observed in the CT scan, such as nodules, abnormal masses, inflammation, etc.

Final Results

This section concludes the observed findings, and it includes the conclusion obtained from the CT scan findings.

CT Imaging Techniques

Conventional Chest CT

This is a routine chest CT scan to observe the general anatomy of the chest. This imaging technique is generally the first-line imaging tool when lung cancer is suspected. It can easily detect abnormalities such as lung masses and nodules, tumor size, margins, and location, cavitation, calcification, necrosis, pleural effusion, and chest wall invasion. A conventional CT scan for lung cancer is widely available, rapid, and provides excellent image resolution. It has a limited capacity to visualize very small nodules or differentiate between benign and malignant tumors.

High Resolution CT (HRCT)

This is a special category of CT, which utilizes very thin slices of the individual scans, which offer high spatial resolution. This technique is mainly used for the evaluation of the lung parenchyma. Apart from using very thin slices for imaging, HRCT also differs from conventional CT as it utilizes a very high frequency of image capture. Generally, HRCT is performed without employing a contrast-enhancing agent. Common lung cancer-related abnormalities observed using HRCT are early lung adenocarcinoma, ground-glass opacities (GGOs), solid and subsolid nodules, and tumor-related interstitial changes. HRCT is an excellent tool for evaluating growth patterns, invasiveness, and a supportive assessment before surgical intervention.

Contrast Enhanced CT (CECT Thorax)

As the name suggests, this CT imaging protocol involves the administration of a contrast-enhancing agent. In CECT, an intravenous iodinated contrast injection is given. This provides better enhancement in the visualization of the anatomy, compared to non-contrast techniques. The use of contrast especially improves the visualization of tumor vascularity, mediastinal structures, lymph nodes, chest wall, and vascular invasion. CECT is also used in Tumor staging (TNM staging), which helps assess the extent of damage due to lung cancer.

CT Guided Biopsy

This CT imaging method is categorized under interventional CT imaging. A biopsy is performed to extract a live tissue sample from the affected site. This procedure is performed to detect peripheral lung nodules and those lesions that are not accessible by a bronchoscopy. In lung cancers, the superficial tissue cannot be used for this purpose. Hence, it is important to accurately detect the site and tissue from which the collection is to be done. For this process, CT imaging is essential to accurately detect the site of the lesions and guide the needle placement. CT-guided biopsy is especially useful when a histopathological confirmation or molecular testing (EGFR, ALK, PD-L1) is required. However, these procedures must be carried out with caution, as there can be risks of pneumothorax or pulmonary hemorrhage.

PET-CT (Hybrid Imaging – CT Component Focus)

PET (Positron Emission Tomography) consists of administering a small, safe amount of radioactive substance into the area under observation. This is called a tracer, which is then tracked for the visualization of the surrounding structures. PET-CT hybrid imaging combines the most effective aspects of both these tests to obtain a premium-quality diagnosis. The CT component contributes to detecting the exact anatomical location of the suspected abnormality. PET is used to track the metabolic reactions occurring in the area. Using this combination of PET-CT visualization, fine anatomical structures like organs, airways, vessels, and bones can be observed to assess the size, shape, and position of the tumor. Due to its high precision and sensitivity, PET-CT imaging is considered the gold standard for detecting and grading lung cancers.

Evaluation

How is pleural and the chest wall involved in lung cancer?

The chest wall is the outermost anatomical layer that protects the internal organs in the chest region, such as the heart, ribs, lungs, sternum, etc. The pleura consists of two membranes- the visceral pleura covering the lungs and the parietal pleura covering the inner side of the chest wall. The space between these membranes is called the pleural space. These organs are crucial for assessing the extent of damage due to lung cancer.

The pleural space can be directly involved in lung cancer (direct tumor growth in this area) or indirectly involved (separated tumor cells seeping into this space). These tumors can also extend to the chest wall in the form of peripheral tumors extending into the chest wall, or indirectly in the form of apical lung cancers.

Once the tumor breaches the visceral pleura, there is no true anatomical barrier, as the tumor can easily grow into the chest wall. As a result of the tumor growth (direct or indirect), abnormalities like pleural inflammation, lesions, and fixation of the lung to the chest wall are developed.

How does CT imaging help in the visualization of airways for lung cancer?

A CT scan can visualize the entire pleural-chest wall complex in a single scan. Using this method, the typical signs of cancer, such as tumor-related soft tissues, pleural space findings, and muscular and osseous structures involved in the pleural space.

Apart from the detection of tumors, a CT scan is also used to grade the level of cancer. E.g., T2 disease is suspected for involvement limited to the visceral pleura, T3 disease is suspected for extension into parietal pleura or chest wall, and so on.

A CT scan is also used as an interventional guide in the determination of surgical resectability, need for en bloc chest wall resection, exclusion from surgery in advanced disease, radiation field planning, and image-guided pleural or chest wall biopsy

Airway Involvement

How are they involved in lung cancer?

The airways in the lungs are tubes ending with the alveoli, and are responsible for carrying the gases to be exchanged. These airways are mainly divided into the upper and lower airways. The upper airway (including the nose, nasal cavity, pharynx, and larynx) is mainly responsible for air uptake and filtration. The lower airway (trachea, bronchitis, bronchioles, and alveolar ducts and sacs) is the structures peasant in the lungs and is involved in the gaseous exchange.

From an anatomical perspective, airways and the lungs are not considered two different organs. The lungs are considered to be the extension of the airways. When it comes to lung cancer, either the cancer originates from the airways or these airways are involved secondarily. Specifically, most types of lung cancers spread through the epithelial cells in the airways and progressively spread to the airway lumen, wall, and surrounding lung tissue.

Based on the site of lung cancer origin in the airways, the site of origin can be the central airway origin (trachea, main bronchi, lobar bronchi) or the peripheral airway origin (terminal bronchioles, respiratory bronchioles, alveolar epithelium). As a result, before there is any visible mass formation, certain signs are observed in the airways, including early wall thickening, loss of smooth mucosal lining, and altered mucus clearing.

In some cases, the tumor grows into the airways and invades the airway walls (specifically the mucosa, submucosa, smooth muscle, and cartilage). In other cases, a growing tumor mass can externally block the airway tubes, leading to its blockage.

In essence, anatomical abnormalities in the airways could be used to identify and locate cancerous or non-cancerous masses in the lungs.

How does CT imaging help in the visualization of airways for lung cancer?

CT imaging is the first-line imaging technique used to observe the airway involvement in lung cancers. It can effectively evaluate the changes in the airway lumen, wall, and surrounding lung parenchyma in a single examination.

Typically, when screening the airways for lung cancer, CT imaging is used to observe the trachea, main bronchi, lobar bronchi, segmental, and subsegmental bronchi. It allows the detection of any soft tissue masses obstructing the airways, abrupt or abnormal bronchial cut off, and partial or complete luminal occlusion. These observations are typical signs of a tumor.

As CT imaging involves observation in sections, it can also assess the parameters explaining the extent of damage caused by a tumor. For this, CT can evaluate the length of the airway affected, the distance from the carina, and the degree of blockage.

Apart from these, CT imaging is also used to evaluate the damage to the lungs caused by tumor-related abnormalities in the arteries. Common indications of such damage are telectasis, obstructive pneumonitis, mucoid impaction, and air trapping.

This information is important to decide the treatment strategy- chemoradiation or surgical removal. It can help guide interventional procedures like bronchoscopy and biopsy, in case these are selected.

Frequently Asked Questions

Why is a CT scan primarily used to detect lung cancers?

Lung cancers generally present misleading symptoms resembling other diseases like bronchitis, asthma, or COPD. To mitigate this problem, a highly sensitive, selective method is required. CT Scanning can accurately differentiate lung cancer from these indications.

Can CT Scanning differentiate malignant nodules from benign ones?

A CT scan can detect certain characteristics of malignant nodules based on size, margins, growth rate, and internal structures. However, it cannot be used to differentiate between malignant and benign tumors. For this purpose, CT imaging must be paired with histopathology or a PET scan.

What are some CT findings that indicate lung cancer?

CT scan findings that indicate lung cancer, especially malignant lung cancer, include spiculated margins, irregular contours, rapid growth, cavitation with thick walls, pleural retraction, bronchial cutoff, and associated lymphadenopathy.

Can CT detect early-stage lung cancer?

Yes. A CT scan visualizes fine histopathological systems using multiple thin slices of the area under evaluation. This technique can effectively detect early-stage cancer signs such as small nodules, ground-glass opacities, and part-solid lesions.

What is the role of contrast-enhancement in CT for lung cancer?

In a conventional CT scan, certain structures appear indistinct. The addition of a contrast-enhancing agent can visualize very fine structures like tumor margins, mediastinal structures, lymph nodes, vascular invasion, and pleura–chest wall involvement.

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