Your email :
Lung Ca Staging Template
Series No # :
Image No # :
Side :
Right
Left
Bilateral
Lobe :
Right Upper Lobe
Right Middle Lobe
Right Lower Lobe
Left Upper Lobe
Left Lower Lower (Lingular segments)
Left Lower Lower (basal segments)
Segment :
Apical (s1) segment
Posterior (s2)segment
Anterior(s3)segment
Lateral (s4)segment
Medial (s5)segment
Superior (s6)segment
Medial_basal (s7)segment
Anterior_basal (s8)segment
Lateral_basal (s9)segment
Posterior_basal (s10)segment
Apicoposterior (s1/2)segment
Anterior (s3)segment
Superior lingular (s4)segment
Inferior lingular (s5)segment
Superior (s6)segment
Anteromedial_basal (s7/8)segment
Lateral_basal (s9)segment
Posterior_basal (s10)segment
Size (cm) :
x
Size :
< 2 cm
2-3 cm
3-5 cm
5-7 cm
> 7 cm
Distance from Carina:
> 2 cm,
< 2 cm.
Invasion of carina
Other lung nodules or masses:
Yes
No
Equivocal
Other lung nodules or masses :
Ipsilateral same side and same lobe
Ipsilateral other lobes
Contralateral lung Nodules
Obstructive atelectasis due to lesion:
Yes
No
Equivocal
Back
Next
Pleural involvement:
Yes
No
Equivocal
Pleural effusion:
Yes
No
Equivocal
Chest wall extension:
Yes
No
Equivocal
Chest wall extension:
Yes
No
Equivocal
Overlying Rib destruction:
Yes
No
Equivocal
Back
Next
Mediastinal structures, Involvement:
Yes
No
Equivocal
Heart and Pericardium: Invasion or Effusion ,
Yes
No
Equivocal
Vessels :
Yes
No
Equivocal
Superior Veno Cava :
Yes
No
Equivocal
Aorta and main branches :
Yes
No
Equivocal
Pulmonary Arteries :
Yes
No
Equivocal
Right
Left
Bilateral
Pulmonary Veins :
Yes
No
Equivocal
Right
Left
Bilateral
Trachea :
Yes
No
Equivocal
Esophagus :
Yes
No
Equivocal
Spine:
Yes
No
Equivocal
Back
Next
Lymphadenopathy :
Yes
No
Equivocal
Regional Lymph Nodes - Hilar lymphadenopathy :
Enlarged
Not enlarged
Equivocal
Ipsi-lateral
Contra-lateral
Bilateral
Regional Lymph Nodes - Mediastinal lymphadenopathy :
Enlarged
Not enlarged
Equivocal
Ipsi-lateral
Contra-lateral
Bilateral
Mediastinal lymphadenopathy :
Superior Mediastinal Nodes enlarged
Aortic Nodes enlarged
Inferior Mediastinal Nodes enlarged
Scalene / Supraclavicular Nodes enlarged
Upper Paratracheal lymph nodes :
Enlarged
Not enlarged
Equivocal
Ipsi-lateral
Contra-lateral
Bilateral
Pre-vascular Lymph Nodes :
Enlarged
Not enlarged
Equivocal
Ipsi-lateral
Contra-lateral
Bilateral
Pre-vertebral Lymph Nodes :
Enlarged
Not enlarged
Equivocal
Ipsi-lateral
Contra-lateral
Bilateral
Lower Paratracheal (including Azygos Nodes) Lymph Nodes :
Enlarged
Not enlarged
Equivocal
Ipsi-lateral
Contra-lateral
Bilateral
Subaortic (A-P window) Lymph Nodes :
Enlarged
Not enlarged
Equivocal
Ipsi-lateral
Contra-lateral
Bilateral
Para-aortic (ascending aorta or phrenic) Lymph Nodes :
Enlarged
Not enlarged
Equivocal
Ipsi-lateral
Contra-lateral
Bilateral
Sub-carinal Lymph Nodes :
Enlarged
Not enlarged
Equivocal
Ipsi-lateral
Contra-lateral
Bilateral
Paraesophageal (below carina) Lymph Nodes :
Enlarged
Not enlarged
Equivocal
Ipsi-lateral
Contra-lateral
Bilateral
Pulmonary Ligament Lymph Nodes :
Enlarged
Not enlarged
Equivocal
Ipsi-lateral
Contra-lateral
Bilateral
Low cervical nodes Lymph Nodes :
Enlarged
Not enlarged
Equivocal
Ipsi-lateral
Contra-lateral
Bilateral
Supraclavicular nodes Lymph Nodes :
Enlarged
Not enlarged
Equivocal
Ipsi-lateral
Contra-lateral
Bilateral
Sternal notch Lymph Nodes :
Enlarged
Not enlarged
Equivocal
Ipsi-lateral
Contra-lateral
Bilateral
Largest measuring
Back
Next
Distant Metastasis :
Yes
No
Equivocal
Metastasis site :
Liver
Adrenal
Renal
Bones
Comment:
Other Additional Detail :
Submit
Print Form
Should be Empty: