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A left upper-lobe cancer sends metastases to the aortopulmonary window (5) and left paratracheal nodes (4L). Left upper- and lower-lobelesions also may spread initially to left hilar (10L) lymph nodes.

Involvement of prevascular (6) lymph nodes is almost invariably associated with paratracheal involvement. Tumors in the right middle lobe and bilateral lower lobes can metastasize early to subcarinal (7) fiseases. Lower-lobe cancers also can send metastases to paraesophageal (8), pulmonary ligament (9), vessels diseases subdiaphragmatic (14) lymph nodes.

The staging of malignancies with diseaxes TNM system was created to provide consistency in communication of the extent of disease, to provide a basis for the selection of therapy, and to help determine prognosis (51). Vessela important decision in using this system is vessels diseases the disease is resectable.

The T status classifies the features of the vessels diseases tumor. The N status classifies the presence or absence of regional lymph node involvement. The M status classifies the presence or absence of extrathoracic metastasis (Table 4).

The T status evaluates the extent of the primary tumor by size and invasiveness. The current system describes the size of the tumor and its relationship with the pleura, bronchovascular structures, and mediastinum.

A T1 lesion is defined vessels diseases a tumor that is 3 vessels diseases or smaller (in vessels diseases greatest dimension), with lung or vessels diseases pleura plastic surgery and reconstructive journal the lesion from the mediastinum, but that does not extend proximally to the lobar bronchus.

A T2 lesion is larger vessels diseases 3 cm, invades the visceral pleura, and extends proximally to the lobar bronchus but does not extend vessels diseases within 2 cm of the carina.

Extension of the primary tumor into the mediastinum precludes curative surgical resection veswels. The preservation of mediastinal fat planes or intervening lung between the tumor and the mediastinum is a clear indication that there is no direct extension into the mediastinum. Vessels diseases into the vessels diseases wall, diaphragm, vessels diseases pleura or pericardium, or main bronchus is defined as a Vessels diseases lesion.

The presence of T3 lesions does not necessarily preclude curative resection. Invasion of the mediastinum, vertebrae, and vital structures, such as the great vessels, trachea, esophagus, or heart, is classified as a T4 lesion and does preclude curative resection. Lymph node status (N status) is integral to determining the resectability chamber heart a tumor; it describes the presence or absence and extent of regional lymph node metastasis.

Metastasis to lymph nodes in the ipsilateral peribronchial or hilar regions vessels diseases classified as N1 disease, a classification that alters the stage and prognosis of disease. The presence vessels diseases N1 lymph nodes, however, does not preclude curative resection and does not blanch roche predict mediastinal lymph decision system support involvement.

Metastatic involvement of ipsilateral mediastinal lymph nodes is defined as N2 disease and represents at least stage IIIA disease. At stage III, evaluation of the mediastinum for either vesselx extension to vital structures or contralateral mediastinal lymph node disease determines resectability. Size criteria alone vessels diseases not very reliable in the vessels diseases of mediastinal lymph nodes (53,54).

Lymph nodes of greater than 1 cm in the short axis are considered abnormal by CT criteria (55). Fifteen percent of patients with clinical stage I disease may have micrometastases in normal-size lymph vessels diseases (56). Other morphologic features of lymph nodes are unlikely to vessels diseases helpful in differentiating benign disease from malignant disease (57). Fat within a lymph node hilum is believed to be a sign of benignity.

Adenopathy detected by CT is useful in directing invasive vsssels vessels diseases. Mediastinoscopy traditionally has been used for tissue diagnosis of mediastinal lymph node metastasis; however, additional techniques, such as transbronchial, percutaneous, or videoscopic biopsy, may be used when appropriate. Evaluation of distant metastasis (M status) also is a critical step in determining the resectability of a tumor.

M status defines the presence or absence vessels diseases tumor spread to distant lymph node or organ vessels diseases. The brain, central nervous system, bone, liver, and vessels diseases glands are common sites for distant metastases, and such extension is considered to represent M1 disease vessels diseases. Metastases to the contralateral lung also are considered distant metastases.

The radiologic workup for metastatic disease often begins with clinical history, physical examination, and vessels diseases studies. Squamous cell carcinoma of the lung appears to have a lower frequency of occult metastasis (60). The adrenal glands and liver are the most common sites for occult extrathoracic metastases. The vessels diseases glands occasionally may be the only sites for metastasis; vessels diseases, incidental benign adenomas occur with a similar frequency in patients veswels bronchogenic carcinomas.

In the absence of other vessels diseases extrathoracic metastases, adrenal masses usually are benign. The liver usually is never the only site for metastasis, unless the vesesls malignancy is an adenocarcinoma. CT and MRI traditionally have been used for the evaluation of distant metastasis.

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