Role of imaging biomarkers in mutation-driven non-small cell lung cancer

Figure 3 Lymphangitic carcinomatosis, pleural metastasis and, extensive lymphadenopathy in 64-year old female non-smoker with ALK-positive non-small cell lung cancer. A: Pretreatment computed tomography (CT) shows a right upper lobe nodule (arrow) corresponding to the primary lung tumor; B: CT slice at the level of the carina shows extensive right sided nodular septal thickening consistent with lymphangitic carcinomatosis; C: CT (mediastinal window) shows extensive right hilar and subcarinal lymphadenopathy (arrowheads) consistent with nodal metastases. A pleural effusion, later proven to be malignant by cytology, is also noted. These features have been associated with ALK-positive non-small cell lung cancer (NSCLC). Similar features have also been described in ROS1-positive NSCLC (Figure 5).