Squamous cell carcinoma of the lung Diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2] Trusha Tank, M.D.[3]

Overview

Computed tomography is the method of choice for the diagnosis of squamous cell carcinoma of the lung. On CT, findings of squamous cell carcinoma of the lung will depend on the location of the tumor. Characteristic findings include ground-glass opacity, rounded or spiculated mass, local nodal involvement, intraluminar obstruction, and lobar collapse. The staging of lung cancer is based on the TNM classification of lung cancer. Lung cancer staging is an assessment of the degree of spread of cancer from its original source. It is an important factor affecting the prognosis and potential treatment of lung cancer. Non-small cell lung carcinoma is staged from IA ("one A", best prognosis) to IVB ("four B", worst prognosis). Biopsy findings associated with squamous cell carcinoma of the lung include prominent nucleoli, eosinophilic cytoplasm, and intracellular bridges. Different sub-types of lung tissue biopsy for squamous cell carcinoma of the lung, include: needle biopsy, open biopsy, and video-assisted thoracoscopic surgery.

Diagnostic Study of Choice

Study of Choice

  • CT is the modality of choice for the evaluation of possible squamous cell carcinoma of the lung
  • Certain morphological features can be suggestive of squamous cell carcinoma of the lung, such as:[1][2]
  • CT features involved in the diagnosis of squamous cell carcinoma of the lung include:
  • Staging of the disease
  • Dictation of the prognosis and treatment
  • CT findings of squamous cell carcinoma of the lung, include:
Central location
Peripheral location
  • Solid nodule/mass with or without an irregular border
  • Irregular margins
  • Desmoplastic reaction or infiltrative growth
  • Similar to central lung cancer, peripheral squamous cell carcinoma of the lung can also result in obstructive changes such as a mucocele.
  • On CT, signs of squamous cell carcinoma of the lung, may include:[3][2]
  • Finger in glove sign: the bronchus distal to the obstruction is dilated
  • Crazy-paving sign: appearance of ground-glass opacity with superimposed interlobular septal thickening and intralobular reticular thickening

Gallery

  • Bronchogenic lung carcincoma: upper lobe collapse via, radiopedia.org Case courtesy of Dr Ahmed Abdrabou, [4]

    Bronchogenic lung carcincoma: upper lobe collapse via, radiopedia.org Case courtesy of Dr Ahmed Abdrabou, [4]

  • Bronchogenic lung carcincoma: upper lobe with lymphangitic spread via, radiopedia.org Case courtesy of Dr Ahmed Abdrabou, [5]

    Bronchogenic lung carcincoma: upper lobe with lymphangitic spread via, radiopedia.org Case courtesy of Dr Ahmed Abdrabou, [5]

  • Squamous cell lung carcinoma: Peripheral squamous cell lung carcinoma may be seen as a solid nodule/mass with or without an irregular border. The irregular margin can be attributed to a desmoplastic reaction or infiltrative growth via, radiopedia.org Case courtesy of Dr Bruno Di Muzio, [6]

    Squamous cell lung carcinoma: Peripheral squamous cell lung carcinoma may be seen as a solid nodule/mass with or without an irregular border. The irregular margin can be attributed to a desmoplastic reaction or infiltrative growth via, radiopedia.org Case courtesy of Dr Bruno Di Muzio, [6]

Staging

The following is 2017 TNM classification of lung cancer.[7][8][9]

T: Primary Tumor

T Description
TX Primary tumor cannot be assessed.
OR
Tumor is demonstrated by the presence of malignant cells in bronchial washings or sputum, but is not visualized by imaging or bronchoscopy.
T0 There is no evidence of primary tumor.
Tis Carcinoma in situ
T1 The tumor has the following characteristics:
  • T1a: tumor ≤1 cm in the largest diameter.
  • T1b: tumor> 1 cm, but ≤2 cm in the largest diameter.
  • T1c: tumor> 2 cm, but ≤3 cm in the largest diameter.
    AND
    The tumor is surrounded by lung or visceral pleura
    AND
    The tumor does not extend to the main bronchus as demonstrated by the absence of bronchoscopic evidence of invasion more proximal than the lobar bronchus.
T2 The tumor has the following characteristics:
  • T2a: tumor > 3 cm, but ≤ 4 cm in the largest diameter.
  • T2b: Tumor > 4 cm, but ≤ 5 cm in the largest diameter.
    The tumor involves the main bronchus, 2 cm or more distal to the carina.
    OR
    The tumor invades the visceral pleura.
    OR
    There is evidence of atelectasis or obstructive pneumonitis that extends to the hilar region without the involvement of the entire lung.
T3 Tumor > 5 cm, but ≤ 7 cm in size.

AND

It directly invades any of the following: chest wall (including superior sulcus tumors), diaphragm, mediastinal pleura, parietal pericardium.
OR
The tumor is localized in the main bronchus at a distance less than 2 cm distal to the carina but without the involvement of the carina.
OR
There is evidence of associated atelectasis or obstructive pneumonitis of the entire lung.

T4 Tumor > 7 cm in size.

The tumor invades any of the following: mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina
OR
There is/are separate tumor nodule(s) in the same lobe.
OR The tumor is associated with malignant pleural effusion.

N:Regional Lymph Nodes

T Description
NX The regional lymph nodes cannot be assessed.
N0 There is no evidence of regional lymph node metastasis.
N1 Metastasis in ipsilateral peribronchial and/or ipsilateral hilum or intrapulmonary lymph nodes

N1a: A lymph node invasion.

N1b: > 1 lymph node affected.

N2 There is metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s).

N2a1: One lymph node infested without lymph node involvement of an N1-defined lymph node station.

N2a2: One lymph node infested with a lymph node of an N1-defined lymph node station

N2b: > 1 lymph node affected

N3 There is metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s).

M: Distant Metastasis

T Description
MX Distant metastasis cannot be assessed.
M0 There is no evidence of distant metastasis.
M1 There is evidence of distant metastasis which includes the presence of separate tumor nodule(s) in a different lobe (ipsilateral or contralateral).

M1a: Tumor foci separated from the primary tumor in a contralateral lung lobe; Tumor with pleural metastases or malignant pleural or pericardial effusion

M1b: Simple metastases in an organ

M1c: Multiple metastases in one organ or one or more metastases in more than one organ


Classification of Lung Cancer by Staging

Stage T N M
Occult carcinoma TX N0 M0
Stage 0 Tis N0 M0
Stage IA1 T1(mi)/T1a N0 M0
Stage IA2 T1b N0 M0
Stage IA3 T1c N0 M0
Stage IB T2a N0 M0
Stage IIA T2b N0 M0
Stage IIB T1a N1 M0
T1c N1 M0
T2a N1 M0
T2b N1 M0
T3 N0 M0
Stage IIIA T1a N2 M0
T1b N2 M0
T1c N2 M0
T2a N2 M0
T2b N2 M0
T1a N2 M0
T1b N2 M0
T1c N2 M0
T2a N2 M0
T2b N2 M0
T3 N1 M0
T4 N0 M0
T4 N1 M0
Stage IIIB T1a N3 M0
T1b N3 M0
T1c N3 M0
T2a N3 M0
T2b N3 M0
T1a N3 M0
T1b N3 M0
T1c N3 M0
T2a N3 M0
T2b N3 M0
T3 N2 M0
T4 N2 M0
Stage IIIC T3 N3 M0
T4 N3 M0
Stage IVA Any T Any N M1a
Any T Any N M1b
Stage IVB Any T Any N M1c


Biopsy

  • Common types of lung tissue biopsy, include:[10]
  • Needle biopsy
  • Open biopsy
  • Video-assisted thoracoscopic surgery (VATS)
  • Indications for lung tissue biopsy in squamous cell carcinoma of the lung, include:[11]
  • Determination of tumor histologic subtype
  • Characterization of genetic mutations
  • Determination of intra or extra-thoracic metastatic disease
  • The table below summarizes the squamous cell carcinoma of the lung biopsy findings.[11]
Type of tumor Biopsy findings
Squamous cell lung carcinoma

References

  1. ↑ Rosado-de-Christenson ML, Templeton PA, Moran CA (1994). "Bronchogenic carcinoma: radiologic-pathologic correlation". Radiographics. 14 (2): 429–46, quiz 447–8. doi:10.1148/radiographics.14.2.8190965. PMID 8190965.
  2. ↑ 2.0 2.1 Parker MS, Chasen MH, Paul N (2009). "Radiologic signs in thoracic imaging: case-based review and self-assessment module". AJR Am J Roentgenol. 192 (3 Suppl): S34–48. doi:10.2214/AJR.07.7081. PMID 19234288.
  3. ↑ Kundel HL (1981). "Predictive value and threshold detectability of lung tumors". Radiology. 139 (1): 25–9. doi:10.1148/radiology.139.1.7208937. PMID 7208937.
  4. ↑ href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/29297">rID: 29297
  5. ↑ href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/29002">rID: 29002
  6. ↑ href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/27915">rID: 27915
  7. ↑ Mountain, CF (2003). A Handbook for Staging, Imaging, and Lymph Node Classification. Charles P Young Company. Retrieved 2007-09-01. Unknown parameter |coauthors= ignored (help)
  8. ↑ Collins, LG (Jan 2007). "Lung cancer: diagnosis and management". American Family Physician. American Academy of Family Physicians. 75 (1): 56–63. PMID 17225705. Retrieved 2007-08-10. Unknown parameter |coauthors= ignored (help)
  9. ↑ Harms, A.; Kriegsmann, M.; Fink, L.; Länger, F.; Warth, A. (2017). "Die neue TNM-Klassifikation für Lungentumoren". Der Pathologe. 38 (1): 11–20. doi:10.1007/s00292-017-0268-y. ISSN 0172-8113.
  10. ↑ Yung RC (2003). "Tissue diagnosis of suspected lung cancer: selecting between bronchoscopy, transthoracic needle aspiration, and resectional biopsy". Respir Care Clin N Am. 9 (1): 51–76. PMID 12820712.
  11. ↑ 11.0 11.1 Squamous cell carcinoma of the lung. Libre Pathology http://librepathology.org/wiki/Squamous_cell_carcinoma_of_the_lung Accessed on March 1, 2016


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