Non small cell lung cancer other diagnostic studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

Other diagnostic modalities for non-small cell lung cancer include thoracotomy, thoracoscopy, bronchoscopy, mediastinoscopy, transthoracic percutaneous fine needle aspiration, and sputum cytology.

Other Diagnostic Studies

Other diagnostic studies may help in the staging of non-small cell cancer. Otehr diagnostice studies for non-small cell lung cancer include:[1]

  • Thoracotomy
  • Thoracoscopy
  • Bronchoscopy
  • Bronchoscopic specimens, include:
  • Bronchial brush
  • Bronchial wash
  • Bronchioloalveolar lavage
  • Transbronchial fine-needle aspiration (FNA)
  • Core biopsy
  • Mediastinoscopy
  • Chamberlain procedure
  • Left parasternal mediastinotomy
  • Anterior mediastinotomy
  • The sensitivity or 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][6][7][8][9][9]

Procedure Advantages Limitations
Thoracotomy
  • Allows the most thorough inspection and sampling of lymph node stations
  • May be followed by resection of tumor, if feasible
  • Invasive approach
  • Not indicated for staging alone
  • Significant risk of procedure-related morbidity
Left parasternal mediastinotomy
  • Allows evaluation of the aortopulmonary window lymph nodes
  • More invasive
  • False-negative rate approximately 10%
Chamberlain procedure
  • Limited applications, invasive
Cervical mediastinoscopy
  • Considered the gold standard (usual comparitor)
  • Excellent for 2RL 4RL
  • 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).
  • False-negative rate approximately 20%
Video-assisted thoracoscopy
  • Useful for the evaluation of inferior mediastinum, station 5 and 6 lymph nodes
  • Invasive
  • Does not cover superior anterior mediastinum
Transthoracic percutaneous fine needle aspiration under CT guidance
  • Widely available than some other methods
  • Traverses a lot of lung tissue
  • High pneumothorax risk
  • Some lymph node stations inaccessible
Bronchoscopy with blind transbronchial Wang needle
  • Less invasive than above methods
  • Relatively low yield
  • Not widely practiced
  • Bleeding risk

References

  1. 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.
  2. name="AJCC4-L">AJCC Cancer Staging Manual 4th edition; Chapter 19; Lung - original pages 115-122
  3. "Archived copy" (PDF). Archived from the original (PDF) on 2011-09-28. Retrieved 2011-05-23.
  4. AJCC Cancer Staging Manual 4th edition; Chapter 19; Lung - original pages 115-122 "Archived copy" (PDF). Archived from the original (PDF) on 2011-09-28. Retrieved 2011-05-23.
  5. 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.
  6. 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.
  7. Mountain, Clifton F; Herman I Libshitz; Kay E Hermes. A Handbook for Staging, Imaging, and Lymph Node Classification. Charles P Young Company.
  8. Mountain CF (June 1997). "Revisions in the International System for Staging Lung Cancer". Chest. 111 (6): 1710–7. doi:10.1378/chest.111.6.1710. PMID 9187198. Archived from the original on 2003-09-05.
  9. 9.0 9.1 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.


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