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AJCC 9th Edition / IASLC staging · CT & radiograph sign libraries · PET (FDG vs DOTATATE) · iRECIST response · deterministic report generation.
T category
—
Insufficient data — enter tumor size and invasion status.
N category
N0
M category
M0
No distant metastases identified.
Stage group
—
AJCC 9 / IASLC
Doubling time
—
Completeness
0%
Tumour size, Laterality and lobe
Examination
Laterality
Lobe
Location descriptors
Long axis
mm
mm
Short axis
mm
mm
Solid component
part-solid
mm
Morphology
Margins
Suspected histology
Interval change
Prior size
mm
mm
Interval
days
d
Spiculation
Margins
Radiating linear strands extending from the nodule margin into adjacent lung without reaching the pleura.
One of the strongest CT morphologic predictors of malignancy.
Lobulation
Margins
Undulating, scalloped nodule contour reflecting uneven growth rates of tumour subclones.
Moderately predictive of malignancy, especially with spiculation.
Pleural tag
Pleura
Thin linear strand extending from a nodule to the visceral pleura, often with a small triangular pleural base.
Common with peripheral adenocarcinoma; does not by itself indicate pleural invasion.
Pleural retraction / indentation
Pleura
Focal inward puckering of the pleural surface adjacent to a nodule.
Suggests fibrotic infiltrative process; raises suspicion for adenocarcinoma.
Vessel convergence sign
Vascular
Pulmonary vessels converging toward and terminating at the nodule margin.
Favours malignancy over a benign pseudo-nodule.
Bronchus sign (positive bronchus sign)
Airway
A bronchus leading directly into or terminating at the nodule.
Markedly increases diagnostic yield of bronchoscopic biopsy.
Bubble lucencies / pseudocavitation
Internal architecture
Small round low-attenuation foci within a nodule representing spared alveoli or ectatic bronchioles, not true necrosis.
Characteristic of lepidic-predominant adenocarcinoma.
Air bronchogram within a nodule/mass
Internal architecture
Air-filled bronchi traversing a soft-tissue opacity.
Suggests a non-obstructive filling process — adenocarcinoma, lymphoma or pneumonia.
CT halo sign
Perilesional
Ground-glass rim surrounding a solid nodule or mass.
Haemorrhage or lepidic tumour spread; context-dependent.
Reverse halo (atoll) sign
Perilesional
Central ground-glass surrounded by a denser ring of consolidation.
Classically organizing pneumonia; also infarct, infection and post-ablation change.
Scar carcinoma
Perilesional
Malignancy arising within or adjacent to an area of established pulmonary fibrosis or scarring.
Easily missed; requires comparison with priors.
Tree-in-bud
Small airways
Centrilobular branching nodular opacities resembling a budding tree.
Usually infectious/inflammatory; rarely tumour emboli.
Lymphangitic carcinomatosis
Interstitial spread
Nodular/beaded interlobular septal thickening and peribronchovascular thickening without architectural distortion.
Indicates advanced intrathoracic disease; poor prognosis.
Chest wall invasion
Local extension
Tumour extension through the parietal pleura into extrapleural fat, muscle or rib.
T3; changes surgical planning to en-bloc resection.
Pulmonary artery encasement
Vascular
Tumour surrounding the pulmonary artery with luminal narrowing or >180° circumferential contact.
Affects resectability and pneumonectomy planning.
Pulmonary vein / left atrial invasion
Vascular
Tumour extension along a pulmonary vein into the left atrium.
T4; risk of tumour embolism.
Bronchial obstruction / endobronchial tumour
Airway
Intraluminal soft tissue causing partial or complete airway occlusion.
Drives atelectasis, post-obstructive pneumonitis and T category.
Distal hyperinflation / air trapping
Airway
Hyperlucent, hyperexpanded lung distal to a partially obstructing lesion (ball-valve effect).
Subtle indirect sign of an endobronchial lesion.
Satellite nodules / skip lesions
Multifocality
Discrete additional tumour nodules separate from the primary.
Same lobe = T3; ipsilateral different lobe = T4; contralateral = M1a.
Cavitation / necrosis
Internal architecture
Gas-containing space within a mass from expulsion of necrotic material through an airway; wall thickness >15 mm favours malignancy.
Thick, irregular walls suggest malignancy; thin smooth walls favour benign disease.
Fissural retraction / transfissural growth
Pleura
Distortion of, or tumour extension across, an interlobar fissure.
Crossing a fissure implies contiguous multilobar involvement and affects lobectomy planning.
Comet tail sign (round atelectasis)
Mimics
Curvilinear vessels and bronchi swirling into a pleural-based mass with adjacent pleural thickening and volume loss.
Reliable sign of a benign lesion.
Visceral pleura
Parietal pleura
Chest wall
Rib
Diaphragm
Pericardium
Heart
Mediastinum
Great vessels
Oesophagus
Trachea
Carina
Main bronchus
Phrenic nerve
Recurrent laryngeal nerve
Vertebral body
Distance to carina
cm
cm
Bronchial obstruction
Atelectasis
Post-obstructive pneumonitis
T category
Insufficient data — enter tumor size and invasion status.
1 — Low cervical / supraclavicular
2R — Upper paratracheal (right)
2L — Upper paratracheal (left)
3A — Prevascular
3P — Retrotracheal
4R — Lower paratracheal (right)
4L — Lower paratracheal (left)
5 — Subaortic (AP window)
6 — Para-aortic
7 — Subcarinal
8R — Paraesophageal (right)
8L — Paraesophageal (left)
9R — Pulmonary ligament (right)
9L — Pulmonary ligament (left)
10R — Hilar (right)
10L — Hilar (left)
11R — Interlobar (right)
11L — Interlobar (left)
12R — Lobar (right)
12L — Lobar (left)
13 — Segmental
14 — Subsegmental
N category N0
No suspicious lymph nodes.
Pleural effusion
Pleural nodularity
Pleural thickening
Pleural plaques
Brain
Bone
Adrenal
Liver
Contralateral lung
Kidney
Pancreas
Peritoneum
Soft tissue
Other metastatic sites
M category M0
No distant metastases identified.