Computertomografische Diagnostik des Lungenkarzinoms und Lungenrundherdes

Zusammenfassung

Das Lungenkarzinom stellt weiterhin eine der häufigsten krebsbedingten Todesursachen in Westeuropa dar. Prognose und Therapieansatz werden wesentlich bestimmt durch die initiale Ausbreitungsdiagnostik. Die Computertomografie wird hierbei oft als Standardmodalität genutzt, ist allerdings hinsichtlich ihrer Sensitivität und Spezifität insbesondere beim N- und M-Staging limitiert, weshalb die S3-Leitlinie die kombinierte PET/CT zum Staging empfiehlt.

Aufgrund der deutlichen Stadienabhängigkeit der Prognose des Lungenkarzinoms ist die möglichst frühe Diagnose der Erkrankung von großer Bedeutung. Allerdings ist die Beurteilung der ­Dignität zufällig diagnostizierter pulmonaler Rund­herde, die mit steigenden CT-Untersuchungszahlen immer häufiger vorkommen, schwierig, außerdem ist das Karzinomrisiko zufällig entdeckter solider pulmonaler Rundherde oft gering. Ein Algorithmus der Fleischner-Society gibt Empfehlungen zur Beurteilung und Kon­trolle derartiger Befunde.

Für die Zukunft ist mit einem verstärkten Einsatz von funktionellen Verfahren wie der PET/CT und der CT-Perfusion zur Prognoseabschätzung und zum Therapiemonitoring beim Lungenkarzinom zu rechnen.

Abstract

Bronchial carcinoma (BC) leads to one of the highest cancer-related mortalities in Western Europe. After diagnosis, the initial cancer staging is essential for therapy selection and estimation of prognosis. Computed tomography (CT) is frequently used as a standard modality for this task, despite being limited regarding its sensitivity and specificity in T-, N- and M-staging. Thus, the S3-guideline recommends combined FDG-PET/CT for staging. Typical findings and limitations are outlined in detail in this article.

Due to the better prognosis for early cancer stages, an early diagnosis of BC is essential. How­ever, the assessment of small solid pulmonary nodules (SPN), which are detected more and more frequently due to rising numbers of CT examinations, is challenging due to the low specificity of CT. In many cases, the risk of malignancy is very low. An algorithm designed by the Fleischner society which is presented in this article can help to decide whether to follow-up these ­lesions.

In the future, functional imaging like PET/CT and CT-Perfusion imaging might play a stronger role in assessment of tumor response and estimation of prognosis.

Schlüsselwörter

Bronchialkarzinom - Lungenkarzinom - pulmonaler Rundherd - Computertomografie

Key words

bronchial carcinoma - solid pulmonary nodule - Fleischner Society - computed tomography

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