Non small cell lung cancer other diagnostic studies: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Non small cell lung cancer}} | {{Non small cell lung cancer}} | ||
{{CMG}}{{AE}}{{MV}} | {{CMG}}{{AE}}{{Trusha}},{{MV}} | ||
==Overview== | ==Overview== | ||
Diagnosis of non-small cell lung cancer can be confirmed by histopathological evaluation and immunohistochemical staining of the tumor specimen obtained from biopsy. Different types of lung tissue biopsy for non-small cell lung cancer include transthoracic needle biopsy, [[Thoracotomy|open biopsy]], and [[Thoracoscopy|video-assisted thoracoscopic surgery (VATS)]]. Specimen for histopathological evaluation and immunohistochemical staining can also be obtained by [[bronchoscopy]], [[mediastinoscopy]], transthoracic percutaneous [[fine needle aspiration]] or sputum cytology. | |||
==Other Diagnostic Studies== | ==Other Diagnostic Studies== | ||
Other diagnostic studies for non-small cell lung cancer include:<ref name="pmid24484269">{{cite journal |vauthors=Kinsey CM, Arenberg DA |title=Endobronchial ultrasound-guided transbronchial needle aspiration for non-small cell lung cancer staging |journal=Am. J. Respir. Crit. Care Med. |volume=189 |issue=6 |pages=640–9 |year=2014 |pmid=24484269 |doi=10.1164/rccm.201311-2007CI |url=}}</ref> | |||
*[[Thoracotomy]] | |||
*[[Thoracoscopy]] | |||
*[[Bronchoscopy]]: [[Bronchoscopy]] is used to obtain a specimen for [[Histopathology|histopathological]] subtyping and [[Immunohistochemistry|immunohistochemical staining]] by the following methods: | |||
::* | **Bronchial brush | ||
**Bronchial wash | |||
**[[Bronchoalveolar lavage|Bronchioloalveolar lavage]] | |||
**[[Fine-needle aspiration|Transbronchial fine-needle aspiration (FNA)]] | |||
* | **Core biopsy | ||
* | |||
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align=center | *[[Mediastinoscopy]] | ||
|valign=top| | **[[Mediastinoscopy|Chamberlain procedure]] | ||
**Left parasternal mediastinotomy | |||
**[[Mediastinoscopy|Anterior mediastinotomy]] | |||
*Transthoracic percutaneous [[fine needle aspiration]] | |||
*Sputum [[cytology]] | |||
**The sensitivity of sputum [[cytology]] varies by location of the [[lung cancer]] | |||
The table below summarizes the advantages and limitations of different types of diagnostic modalities in non-small cell lung cancer arranged from the most to the least invasive.<ref name="pmid4000199">{{cite journal |vauthors=Feinstein AR, Sosin DM, Wells CK |title=The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer |journal=N. Engl. J. Med. |volume=312 |issue=25 |pages=1604–8 |date=June 1985 |pmid=4000199|doi=10.1056/NEJM198506203122504|url=}}</ref><ref name="pmid18663166">{{cite journal |vauthors=Chee KG, Nguyen DV, Brown M, Gandara DR, Wun T, Lara PN |title=Positron emission tomography and improved survival in patients with lung cancer: the Will Rogers phenomenon revisited |journal=Arch. Intern. Med. |volume=168 |issue=14 |pages=1541–9|date=July 2008|pmid=18663166 |doi=10.1001/archinte.168.14.1541 |url=}}</ref><ref name="urlwww.lung.org">{{cite web |url=https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/lung-cancer/learn-about-lung-cancer/how-is-lung-cancer-diagnosed/ |title=www.lung.org |format= |work= |accessdate=}}</ref><ref name="urlLung Cancer 101 | Lungcancer.org">{{cite web |url=https://www.lungcancer.org/find_information/publications/163-lung_cancer_101/267-diagnosing_lung_cancer |title=Lung Cancer 101 | Lungcancer.org |format= |work= |accessdate=}}</ref> | |||
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center" | |||
| valign="top" | | |||
|+ | |+ | ||
|- | |- | ||
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Procedure}} | ! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Procedure}} | ||
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Advantages}} | ! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Advantages}} | ||
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF| | ! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Limitations}} | ||
|- | |- | ||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| [[Thoracotomy]] | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Thoracotomy]] | ||
|style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Allows the most thorough inspection and sampling of lymph node stations | *Allows the most thorough inspection and sampling of [[Lymph node metastases|lymph node]] stations | ||
*May be followed by resection of tumor, if feasible | *May be followed by resection of he tumor, if feasible | ||
|style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Invasive approach | *Invasive approach | ||
*Not indicated for staging alone | *Not indicated for staging alone | ||
*Significant risk of procedure-related morbidity | *Significant risk of procedure-related morbidity | ||
|- | |- | ||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| Left parasternal mediastinotomy | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Left parasternal mediastinotomy | ||
|style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Allows evaluation of the aortopulmonary window lymph nodes | *Allows evaluation of the aortopulmonary window lymph nodes | ||
|style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*More invasive | *More invasive | ||
*False-negative rate approximately 10% | *False-negative rate approximately 10% | ||
|- | |- | ||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| Chamberlain procedure | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Chamberlain procedure | ||
|style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Access to station 5 ([[aortopulmonary window]] lymph node) | *Access to station 5 ([[aortopulmonary window]] lymph node) | ||
|style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Limited applications, invasive | *Limited applications, invasive | ||
|- | |- | ||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| [[Mediastinoscopy|Cervical mediastinoscopy]] | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Mediastinoscopy|Cervical mediastinoscopy]] | ||
|style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Considered the gold standard (usual comparitor) | *Considered the gold standard (usual comparitor) | ||
*Excellent for 2RL 4RL | *Excellent for 2RL 4RL | ||
|style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Invasive | *Invasive | ||
*Does not cover all mediastinal lymph node stations; particularly subcarinal lymph nodes (station 7), paraesophageal and pulmonary ligament lymph nodes (stations 8 and 9). | *Does not cover all [[mediastinal lymph node]] stations; particularly [[Mediastinal lymph node|subcarinal lymph nodes]] (station 7), paraesophageal and pulmonary ligament lymph nodes (stations 8 and 9). | ||
*False-negative rate approximately 20% | *[[False-negative|False-negative rate]] approximately 20% | ||
|- | |- | ||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| [[Thoracoscopy|Video-assisted thoracoscopy]] | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Thoracoscopy|Video-assisted thoracoscopy]] | ||
|style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Useful for the evaluation of inferior mediastinum, station 5 and 6 lymph nodes | *Useful for the evaluation of [[inferior mediastinum]], station 5 and 6 lymph nodes | ||
|style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Invasive | *Invasive | ||
*Does not cover superior anterior mediastinum | *Does not cover [[Superior mediastinum|superior anterior mediastinum]] | ||
|- | |- | ||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| Transthoracic percutaneous [[fine needle aspiration]] | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Transthoracic percutaneous [[fine needle aspiration]] under CT guidance<ref name="pmid17296659">{{cite journal |vauthors=Micames CG, McCrory DC, Pavey DA, Jowell PS, Gress FG |title=Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: A systematic review and metaanalysis |journal=Chest |volume=131 |issue=2 |pages=539–48|date=February 2007 |pmid=17296659|doi=10.1378/chest.06-1437|url=http://www.chestjournal.org/cgi/content/full/131/2/539}}</ref> | ||
|style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Widely available than some other methods | *Widely available than some other methods | ||
|style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Traverses a lot of lung tissue | *Traverses a lot of lung tissue | ||
*High pneumothorax risk | *High pneumothorax risk | ||
*Some lymph node stations inaccessible | *Some lymph node stations inaccessible | ||
|- | |- | ||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| [[Bronchoscopy]] with blind transbronchial | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Bronchoscopy]] with blind transbronchial Wang needle | ||
|style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Less invasive than above methods | *Less invasive than above methods | ||
|style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Relatively low yield | *Relatively low yield | ||
*Not widely practiced | *Not widely practiced | ||
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|} | |} | ||
==Biopsy== | |||
Common types of lung tissue biopsy include:<ref name="pmid12820712">{{cite journal |vauthors=Yung RC |title=Tissue diagnosis of suspected lung cancer: selecting between bronchoscopy, transthoracic needle aspiration, and resectional biopsy |journal=Respir Care Clin N Am |volume=9 |issue=1 |pages=51–76 |year=2003 |pmid=12820712 |doi= |url=}}</ref><ref name="NSCLS2">Squamous cell carcinoma of the lung. Libre Pathology http://librepathology.org/wiki/Squamous_cell_carcinoma_of_the_lung Accessed on March 1, 2016</ref> | |||
*[[Needle biopsy]] | |||
*Open biopsy | |||
*Video-assisted [[Thoracoscopy|thoracoscopic]] surgery (VATS) | |||
Indications for lung tissue biopsy in suspected non-small cell lung cancer include:<ref name="NSCLS2">Squamous cell carcinoma of the lung. Libre Pathology http://librepathology.org/wiki/Squamous_cell_carcinoma_of_the_lung Accessed on March 1, 2016</ref> | |||
*Determination of tumor [[histologic]] subtype | |||
*Characterization of [[genetic mutations]] | |||
*Determination of intra or extra-thoracic metastatic disease | |||
==Biopsy Findings== | |||
*The table below summarizes the common types of non-small cell lung cancer biopsy findings. | |||
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center" | |||
| valign="top" | | |||
|+ | |||
|- | |||
! style="background: #4479BA; width: 50px;" | {{fontcolor|#FFF|Type of tumor }} | |||
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Biopsy findings}} | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Lung adenocarcinoma]]<ref name="pmid25806193">{{cite journal |vauthors=Thunnissen E |title=Pulmonary adenocarcinoma histology |journal=Transl Lung Cancer Res |volume=1 |issue=4 |pages=276–9 |date=December 2012 |pmid=25806193 |pmc=4367552 |doi=10.3978/j.issn.2218-6751.2012.10.11 |url=}}</ref> | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Nuclear [[atypia]] | |||
*Eccentrically placed nuclei | |||
*Abundant cytoplasm - classically with [[Mucin|mucin vacuoles]] | |||
*Often conspicuous [[nucleoli]] | |||
*[[Nuclear pseudoinclusions]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Squamous-cell cancer|Squamous cell lung carcinoma]]<ref name="pmid28815199">{{cite journal |vauthors=Suarez E, Knollmann-Ritschel BEC |title=Squamous Cell Carcinoma of the Lung |journal=Acad Pathol |volume=4 |issue= |pages=2374289517705950 |date=2017 |pmid=28815199 |pmc=5528918 |doi=10.1177/2374289517705950 |url=}}</ref> | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Central nucleus | |||
*Dense appearing cytoplasm, usually [[eosinophilic]] | |||
*Small nucleolus | |||
*Intracellular bridges - classic | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Large cell carcinoma of the lung|Large cell lung carcinoma]]<ref name="pmid16107574">{{cite journal |vauthors=Miller YE |title=Pathogenesis of lung cancer: 100 year report |journal=Am. J. Respir. Cell Mol. Biol. |volume=33 |issue=3 |pages=216–23 |date=September 2005 |pmid=16107574 |pmc=2715312 |doi=10.1165/rcmb.2005-0158OE |url=}}</ref> | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Large polygonal cells and [[Anaplasia|anaplastic cells]] | |||
*Solid nests without obvious [[Squamous cell|squamous]] or [[Glandular|glandular differentiation]] | |||
*Moderately abundant cytoplasm | |||
*Well defined cell borders | |||
*Vesicular nuclei, prominent nucleoli | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Adenosquamous carcinoma]]<ref name="pmid161075743">{{cite journal |vauthors=Miller YE |title=Pathogenesis of lung cancer: 100 year report |journal=Am. J. Respir. Cell Mol. Biol. |volume=33 |issue=3 |pages=216–23 |year=2005 |pmid=16107574 |pmc=2715312 |doi=10.1165/rcmb.2005-0158OE |url=}}</ref> | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Substantial amounts of squamous and glandular differentiation | |||
*Positive stains for TTF1 and p63 in squamous component | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Sarcomatoid carcinoma of the lung|Sarcomatoid carcinoma]]<ref name="pmid19830024">{{cite journal |vauthors=Hountis P, Moraitis S, Dedeilias P, Ikonomidis P, Douzinas M |title=Sarcomatoid lung carcinomas: a case series |journal=Cases J |volume=2 |issue= |pages=7900 |date=June 2009 |pmid=19830024 |pmc=2740247 |doi=10.4076/1757-1626-2-7900 |url=}}</ref> | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Sarcoma-like differentiation | |||
*Spindle cells vary morphologically from epithelioid to strikingly spindled and are arranged in haphazard fascicles or storiform pattern | |||
*Moderate to abundant, dense, eosinophilic cytoplasm | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Carcinoid tumor]]<ref name="pmid25412850">{{cite journal |vauthors=Reid MD, Bagci P, Ohike N, Saka B, Erbarut Seven I, Dursun N, Balci S, Gucer H, Jang KT, Tajiri T, Basturk O, Kong SY, Goodman M, Akkas G, Adsay V |title=Calculation of the Ki67 index in pancreatic neuroendocrine tumors: a comparative analysis of four counting methodologies |journal=Mod. Pathol. |volume=28 |issue=5 |pages=686–94 |date=May 2015 |pmid=25412850 |pmc=4460192 |doi=10.1038/modpathol.2014.156 |url=}}</ref> | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Medium sized polygonal cells with lightly eosinophilic cytoplasm | |||
*Low nuclear grade, round to oval finely granular nuclei; may have rosettes or small acinar structures with variable mucin | |||
*Scanty vascular stroma, occasionally amyloid stroma with bone | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Salivary gland tumor]]<ref>{{Cite journal | author = [[Marco Guzzo]], [[Laura D. Locati]], [[Franz J. Prott]], [[Gemma Gatta]], [[Mark McGurk]] & [[Lisa Licitra]] | |||
| title = Major and minor salivary gland tumors | journal = [[Critical reviews in oncology/hematology]] | volume = 74 | issue = 2 | pages = 134–148 | year = 2010 | |||
| month = May | doi = 10.1016/j.critrevonc.2009.10.004 | pmid = 019939701}}</ref> | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Organized in round and sometimes confluent islands, rich in matrix and with dispersed condrocyte-type cells | |||
|- | |||
|} | |||
==Immunohistochemistry Stain== | |||
'''On immunohistochemistry''', the findings depend on the histological type of non-small cell lung cancer.<ref name="pmid19466276">{{cite journal |vauthors=Capelozzi VL |title=Role of immunohistochemistry in the diagnosis of lung cancer |journal=J Bras Pneumol |volume=35 |issue=4 |pages=375–82 |year=2009 |pmid=19466276 |doi= |url=}}</ref> | |||
*Common immunohistochemistry markers used for non-small cell carcinoma subtyping, include: | |||
*TTF-1 for adenocarcinoma | |||
*p63 and high-molecular-weight keratins for squamous cell carcinoma | |||
*Lack of staining with neuroendocrine markers ([[chromogranin A]], synaptophysin, and [[CD56]]) | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Types of cancer]] | [[Category:Types of cancer]] | ||
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{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
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Latest revision as of 19:36, 22 January 2019
Non Small Cell Lung Cancer Microchapters |
Differentiating Non Small Cell Lung Cancer from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2],Maria Fernanda Villarreal, M.D. [3]
Overview
Diagnosis of non-small cell lung cancer can be confirmed by histopathological evaluation and immunohistochemical staining of the tumor specimen obtained from biopsy. Different types of lung tissue biopsy for non-small cell lung cancer include transthoracic needle biopsy, open biopsy, and video-assisted thoracoscopic surgery (VATS). Specimen for histopathological evaluation and immunohistochemical staining can also be obtained by bronchoscopy, mediastinoscopy, transthoracic percutaneous fine needle aspiration or sputum cytology.
Other Diagnostic Studies
Other diagnostic studies for non-small cell lung cancer include:[1]
- Thoracotomy
- Thoracoscopy
- Bronchoscopy: Bronchoscopy is used to obtain a specimen for histopathological subtyping and immunohistochemical staining by the following methods:
- Bronchial brush
- Bronchial wash
- Bronchioloalveolar lavage
- Transbronchial fine-needle aspiration (FNA)
- Core biopsy
- Mediastinoscopy
- Chamberlain procedure
- Left parasternal mediastinotomy
- Anterior mediastinotomy
- Transthoracic percutaneous fine needle aspiration
- Sputum cytology
- The sensitivity of sputum cytology varies by location of the lung cancer
The table below summarizes the advantages and limitations of different types of diagnostic modalities in non-small cell lung cancer arranged from the most to the least invasive.[2][3][4][5]
Procedure | Advantages | Limitations |
---|---|---|
Thoracotomy |
|
|
Left parasternal mediastinotomy |
|
|
Chamberlain procedure |
|
|
Cervical mediastinoscopy |
|
|
Video-assisted thoracoscopy |
|
|
Transthoracic percutaneous fine needle aspiration under CT guidance[6] |
|
|
Bronchoscopy with blind transbronchial Wang needle |
|
|
Biopsy
Common types of lung tissue biopsy include:[7][8]
- Needle biopsy
- Open biopsy
- Video-assisted thoracoscopic surgery (VATS)
Indications for lung tissue biopsy in suspected non-small cell lung cancer include:[8]
- Determination of tumor histologic subtype
- Characterization of genetic mutations
- Determination of intra or extra-thoracic metastatic disease
Biopsy Findings
- The table below summarizes the common types of non-small cell lung cancer biopsy findings.
Type of tumor | Biopsy findings |
---|---|
Lung adenocarcinoma[9] |
|
Squamous cell lung carcinoma[10] |
|
Large cell lung carcinoma[11] |
|
Adenosquamous carcinoma[12] |
|
Sarcomatoid carcinoma[13] |
|
Carcinoid tumor[14] |
|
Salivary gland tumor[15] |
|
Immunohistochemistry Stain
On immunohistochemistry, the findings depend on the histological type of non-small cell lung cancer.[16]
- Common immunohistochemistry markers used for non-small cell carcinoma subtyping, include:
- TTF-1 for adenocarcinoma
- p63 and high-molecular-weight keratins for squamous cell carcinoma
- Lack of staining with neuroendocrine markers (chromogranin A, synaptophysin, and CD56)
References
- ↑ Kinsey CM, Arenberg DA (2014). "Endobronchial ultrasound-guided transbronchial needle aspiration for non-small cell lung cancer staging". Am. J. Respir. Crit. Care Med. 189 (6): 640–9. doi:10.1164/rccm.201311-2007CI. PMID 24484269.
- ↑ Feinstein AR, Sosin DM, Wells CK (June 1985). "The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer". N. Engl. J. Med. 312 (25): 1604–8. doi:10.1056/NEJM198506203122504. PMID 4000199.
- ↑ Chee KG, Nguyen DV, Brown M, Gandara DR, Wun T, Lara PN (July 2008). "Positron emission tomography and improved survival in patients with lung cancer: the Will Rogers phenomenon revisited". Arch. Intern. Med. 168 (14): 1541–9. doi:10.1001/archinte.168.14.1541. PMID 18663166.
- ↑ "www.lung.org".
- ↑ "Lung Cancer 101 | Lungcancer.org".
- ↑ Micames CG, McCrory DC, Pavey DA, Jowell PS, Gress FG (February 2007). "Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: A systematic review and metaanalysis". Chest. 131 (2): 539–48. doi:10.1378/chest.06-1437. PMID 17296659.
- ↑ Yung RC (2003). "Tissue diagnosis of suspected lung cancer: selecting between bronchoscopy, transthoracic needle aspiration, and resectional biopsy". Respir Care Clin N Am. 9 (1): 51–76. PMID 12820712.
- ↑ 8.0 8.1 Squamous cell carcinoma of the lung. Libre Pathology http://librepathology.org/wiki/Squamous_cell_carcinoma_of_the_lung Accessed on March 1, 2016
- ↑ Thunnissen E (December 2012). "Pulmonary adenocarcinoma histology". Transl Lung Cancer Res. 1 (4): 276–9. doi:10.3978/j.issn.2218-6751.2012.10.11. PMC 4367552. PMID 25806193.
- ↑ Suarez E, Knollmann-Ritschel B (2017). "Squamous Cell Carcinoma of the Lung". Acad Pathol. 4: 2374289517705950. doi:10.1177/2374289517705950. PMC 5528918. PMID 28815199. Vancouver style error: initials (help)
- ↑ Miller YE (September 2005). "Pathogenesis of lung cancer: 100 year report". Am. J. Respir. Cell Mol. Biol. 33 (3): 216–23. doi:10.1165/rcmb.2005-0158OE. PMC 2715312. PMID 16107574.
- ↑ Miller YE (2005). "Pathogenesis of lung cancer: 100 year report". Am. J. Respir. Cell Mol. Biol. 33 (3): 216–23. doi:10.1165/rcmb.2005-0158OE. PMC 2715312. PMID 16107574.
- ↑ Hountis P, Moraitis S, Dedeilias P, Ikonomidis P, Douzinas M (June 2009). "Sarcomatoid lung carcinomas: a case series". Cases J. 2: 7900. doi:10.4076/1757-1626-2-7900. PMC 2740247. PMID 19830024.
- ↑ Reid MD, Bagci P, Ohike N, Saka B, Erbarut Seven I, Dursun N, Balci S, Gucer H, Jang KT, Tajiri T, Basturk O, Kong SY, Goodman M, Akkas G, Adsay V (May 2015). "Calculation of the Ki67 index in pancreatic neuroendocrine tumors: a comparative analysis of four counting methodologies". Mod. Pathol. 28 (5): 686–94. doi:10.1038/modpathol.2014.156. PMC 4460192. PMID 25412850.
- ↑ Marco Guzzo, Laura D. Locati, Franz J. Prott, Gemma Gatta, Mark McGurk & Lisa Licitra (2010). "Major and minor salivary gland tumors". Critical reviews in oncology/hematology. 74 (2): 134–148. doi:10.1016/j.critrevonc.2009.10.004. PMID 019939701. Unknown parameter
|month=
ignored (help) - ↑ Capelozzi VL (2009). "Role of immunohistochemistry in the diagnosis of lung cancer". J Bras Pneumol. 35 (4): 375–82. PMID 19466276.