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Multifocal Lung Cancer
Tyler H. Ternes, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Multiple primary lung cancers, clinical criteria
                  • Synchronous: 2 or more separate lung cancers detected simultaneously, without systemic metastases
                    • If same histology, should be in different lobes, without N2 or N3 disease
                  • Metachronous: Detection of 2 or more lung cancers separated by time, without systemic metastases
                    • If same histology, ≥ 2-year interval
                • Primary lung cancer with satellite lesion(s)
                  • Lesions of same histology within same lobe regardless of size, without systemic metastases
                • Hematogenous metastases
                  • Lung cancer with multiple lung metastases of same histology
                  • Lesions of same histology in different lobes with N2 or N3 disease

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • Staging, Grading, & Classification

                            CLINICAL ISSUES

                            • Presentation

                              • Natural History & Prognosis

                                • Evaluation

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      Selected References

                                      1. Zheng R et al: Molecular profiling of key driver genes improves staging accuracy in multifocal non-small cell lung cancer. J Thorac Cardiovasc Surg. 160(2):e71-9, 2020
                                      2. Carter BW et al: Revisions to the TNM staging of lung cancer: rationale, significance, and clinical application. Radiographics. 38(2):374-91, 2018
                                      3. Kozower BD et al: Special treatment issues in non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 143(5 Suppl):e369S-99S, 2013
                                      4. Travis WD et al: International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol. 6(2):244-85, 2011
                                      5. Tanvetyanon T et al: Relationship between tumor size and survival among patients with resection of multiple synchronous lung cancers. J Thorac Oncol. 5(7):1018-24, 2010
                                      6. Godoy MC et al: Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung: recommended interim guidelines for assessment and management. Radiology. 253(3):606-22, 2009
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Pathology

                                              • Clinical Issues

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Definitions

                                                    • Multiple primary lung cancers, clinical criteria
                                                      • Synchronous: 2 or more separate lung cancers detected simultaneously, without systemic metastases
                                                        • If same histology, should be in different lobes, without N2 or N3 disease
                                                      • Metachronous: Detection of 2 or more lung cancers separated by time, without systemic metastases
                                                        • If same histology, ≥ 2-year interval
                                                    • Primary lung cancer with satellite lesion(s)
                                                      • Lesions of same histology within same lobe regardless of size, without systemic metastases
                                                    • Hematogenous metastases
                                                      • Lung cancer with multiple lung metastases of same histology
                                                      • Lesions of same histology in different lobes with N2 or N3 disease

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • Nuclear Medicine Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • Staging, Grading, & Classification

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Natural History & Prognosis

                                                                    • Evaluation

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Consider

                                                                          Selected References

                                                                          1. Zheng R et al: Molecular profiling of key driver genes improves staging accuracy in multifocal non-small cell lung cancer. J Thorac Cardiovasc Surg. 160(2):e71-9, 2020
                                                                          2. Carter BW et al: Revisions to the TNM staging of lung cancer: rationale, significance, and clinical application. Radiographics. 38(2):374-91, 2018
                                                                          3. Kozower BD et al: Special treatment issues in non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 143(5 Suppl):e369S-99S, 2013
                                                                          4. Travis WD et al: International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol. 6(2):244-85, 2011
                                                                          5. Tanvetyanon T et al: Relationship between tumor size and survival among patients with resection of multiple synchronous lung cancers. J Thorac Oncol. 5(7):1018-24, 2010
                                                                          6. Godoy MC et al: Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung: recommended interim guidelines for assessment and management. Radiology. 253(3):606-22, 2009