9. Tnm Sınıflandırması Döneminde Akciğer Kanseri Evrelemesi: Yenilikler ve Modern Radyolojik Yaklaşımlar
Synopsis
The ninth edition of the TNM classification for lung cancer came into effect on 1 January 2025. It is based on analyses of the IASLC database of 124,581 patients diagnosed between 2011 and 2019. The T descriptors remain unchanged, but the N and M categories have been substantially revised. N2 disease is now subdivided by the number of involved anatomical nodal stations into N2a (single station) and N2b (multiple stations). M1c is split by the number of involved extrathoracic organ systems into M1c1 and M1c2. These changes produce notable stage migration. T1N1 tumours move from IIB to IIA, T1N2a from IIIA to IIB, and T3N2a from IIIB to IIIA, whereas T2N2b tumours are upstaged from IIIA to IIIB. This chapter summarises these changes from a radiologist's perspective. It uses illustrative images to discuss solid-component measurement in subsolid lesions, assessment of visceral pleural invasion, station-based nodal reporting and organ-system-based evaluation of metastases. It also reviews the current evidence on [18F]FDG PET/CT versus PET/MRI, structured reporting with Node-RADS, and deep learning radiomics for mediastinal nodal assessment.
References
Asamura H, Nishimura KK, Giroux DJ, et al. IASLC Lung Cancer Staging Project: A new database to inform revisions in the ninth edition of the TNM classification of lung cancer. Journal of Thoracic Oncology. 2023;18(5): 564–75. doi:10.1016/j.jtho.2023.01.088
Kuhtić I, Mandić Paulić T, Kovačević L, et al. Clinical TNM lung cancer staging: A diagnostic algorithm with a pictorial review. Diagnostics. 2025;15(7): 908. doi:10.3390/diagnostics15070908
Argentieri G, Valsecchi C, Petrella F, et al. Implementation of the 9th TNM Classification of Malignant Tumors for lung cancer: Practical insights for radiologists. European Radiology. 2025;35(7): 4395–402. doi:10.1007/s00330-024-11345-8
Kifjak D, Mura R, Khenkina N, et al. Something old, something new—Introduction to the ninth edition of the TNM classification of lung cancer. British Journal of Radiology. 2025;98(1174): 1543–55. doi:10.1093/bjr/tqaf161
Constantinescu A, Căprariu RN, Stoicescu ER, et al. From TNM 8 to TNM 9: Stage migration and histology-specific patterns in lung cancer. Cancers. 2025;17(20): 3290. doi:10.3390/cancers17203290
Yu D, Chen C. [18F]FDG PET/CT versus [18F]FDG PET/MRI in the staging of non-small cell lung cancer: A head-to-head comparative meta-analysis. Frontiers in Medicine. 2025;11: 1517805. doi:10.3389/fmed.2024.1517805
Duan F, Zu H, Zhang R, et al. Deep learning radiomics and 18F-FDG PET/CT imaging: Mediastinal lymph node characteristics as predictors of metastasis in non-small cell lung cancer. Translational Lung Cancer Research. 2025;14(10): 4301–14. doi:10.21037/tlcr-2025-650
Elsholtz FHJ, Asbach P, Haas M, et al. Introducing the Node Reporting and Data System 1.0 (Node-RADS): A concept for the standardized assessment of lymph nodes in cancer. European Radiology. 2021;31: 6116–24.
