Pancoast tumor other diagnostic studies: Difference between revisions

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Latest revision as of 18:14, 16 March 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mazia Fatima, MBBS [2]

Overveiw

Other diagnostic studies for evaluating the spread of Pancoast tumor include pulmonary angiography, molecular tests, and biopsy.

Other Diagnostic Studies

Other diagnostic studies for evaluating the spread of Pancoast tumor include pulmonary angiography, molecular tests, and biopsy.

Pulmonary Angiography

On pulmonary angiography, findings of Pancoast tumor may be used for:^[1]

Evaluation of central pulmonary artery invasion

Molecular Test

Molecular tests include epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) mutation. Specific targeted agents may be administered to patients if these mutations are present. A transthoracic needle biopsy and a bronchoscopy are conducted to diagnose lung cancer.

Biopsy

A transthoracic needle biopsy, guided by CT or fluoroscopy, is for pancoast tumors located in the periphery of the lungs since peripheral tumors are not accessible through a bronchoscope.^[2]^[3]

Other diagnostic modalities for pancoast tumor include:^[2]

Chamberlain procedure
Left parasternal mediastinotomy
Anterior mediastinotomy

The sensitivity or sputum cytology varies by location of the lung cancer

The majority of these procedures allow staging of mediastinal lymph nodes.
The table below summarizes the different types of diagnostic modalities for Pancoast tumor arranged from the most to the least invasive.^[4]


Procedure	Advantages	Disadvantages
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	Access to station 5 (aortopulmonary window lymph node)	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

↑ Delarue NC, Sanders DE, Silverberg SA (1970). "Complementary value of pulmonary angiography and mediastinoscopy in individualizing treatment for patients with lung cancer". Cancer. 26 (6): 1370–8. PMID 5483666.
↑ ^2.0 ^2.1 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.<ref name="pmid12820712">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.
↑ Squamous cell carcinoma of the lung. Libre Pathology http://librepathology.org/wiki/Squamous_cell_carcinoma_of_the_lung Accessed on March 1, 2016
↑ Lung Cancer Staging. Wikipedia.https://en.wikipedia.org/wiki/Lung_cancer_staging Accessed on March 1, 2015

Template:WH Template:WS

[pmid5483666-1] Delarue NC, Sanders DE, Silverberg SA (1970). "Complementary value of pulmonary angiography and mediastinoscopy in individualizing treatment for patients with lung cancer". Cancer. 26 (6): 1370–8. PMID 5483666.

[pmid24484269-2] 2.0 ^2.1 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.<ref name="pmid12820712">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.

[NSCLS2-3] Squamous cell carcinoma of the lung. Libre Pathology http://librepathology.org/wiki/Squamous_cell_carcinoma_of_the_lung Accessed on March 1, 2016

[staging-4] Lung Cancer Staging. Wikipedia.https://en.wikipedia.org/wiki/Lung_cancer_staging Accessed on March 1, 2015

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[2]

[3]

[4]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Pancoast tumor}}
-{{CMG}}{{AE}}{{Mazia}}
+{{CMG}}; {{AE}} {{Mazia}}
 ==Overveiw==
-Other diagnostic studies for evaluating the spread of Pancoast tumor include bone scintigraphy, [[PET scan]], and molecular tests.
+Other [[diagnostic]] studies for evaluating the spread of Pancoast tumor include [[pulmonary angiography]], molecular tests, and [[biopsy]].
 ==Other Diagnostic Studies==
-Other diagnostic studies for evaluating the spread of Pancoast tumor include bone scintigraphy, [[PET scan]], molecular tests, biopsy.
+Other [[diagnostic]] studies for evaluating the spread of Pancoast tumor include [[pulmonary angiography]], molecular tests, and [[biopsy]].
+===Pulmonary Angiography===
+*On [[pulmonary angiography]], findings of Pancoast tumor may be used for:<ref name="pmid5483666">{{cite journal |vauthors=Delarue NC, Sanders DE, Silverberg SA |title=Complementary value of pulmonary angiography and mediastinoscopy in individualizing treatment for patients with lung cancer |journal=Cancer |volume=26 |issue=6 |pages=1370–8 |year=1970 |pmid=5483666 |doi= |url=}}</ref>
+:*Evaluation of central [[pulmonary artery]] [[invasion]]
-===Bone Scintigraphy===
+===Molecular Test===
-A bone scan may demonstrate bone metastases.
+Molecular tests include [[epidermal growth factor receptor]] ([[EGFR]]) [[Mutations|mutation]] and [[anaplastic lymphoma kinase]] (ALK) [[mutation]]. Specific targeted agents may be administered to [[patients]] if these [[mutations]] are present. A [[Transthoracic needle aspiration|transthoracic needle biopsy]] and a [[bronchoscopy]] are conducted to [[diagnose]] [[lung cancer]].
-===PET scan===
-*[[Fluorodeoxyglucose|FDG]](18 F fluoro deoxyglucose) [[Positron emission tomography|PET scans]] along with [[contrast enhanced CT]] may be helpful in the diagnosis of extent of lung cancer. Findings on FDGPET/CT suggestive of lung cancer include:<ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>
+===Biopsy===
-**Solitary pulmonary nodule
+A [[Transthoracic needle aspiration|transthoracic needle biopsy]], guided by [[CT-scans|CT]] or [[fluoroscopy]], is for pancoast tumors located in the [[periphery]] of the [[lungs]] since [[Periphery|peripheral]] [[tumors]] are not accessible through a [[bronchoscope]].<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=}}<nowiki><ref name="pmid12820712"></nowiki>{{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>
-*Benefits of FDGPET/CT include:<ref name="van BaardwijkBaumert2006">{{cite journal|last1=van Baardwijk|first1=Angela|last2=Baumert|first2=Brigitta G.|last3=Bosmans|first3=Geert|last4=van Kroonenburgh|first4=Marinus|last5=Stroobants|first5=Sigrid|last6=Gregoire|first6=Vincent|last7=Lambin|first7=Philippe|last8=De Ruysscher|first8=Dirk|title=The current status of FDG–PET in tumour volume definition in radiotherapy treatment planning|journal=Cancer Treatment Reviews|volume=32|issue=4|year=2006|pages=245–260|issn=03057372|doi=10.1016/j.ctrv.2006.02.002}}</ref>
-**Accurate delineation of the viable tumor from surrounding [[atelectasis]] and [[Collapsed lung|collapse]] or [[Consolidation (medicine)|consolidation]].
+*Other [[diagnostic]] modalities for pancoast tumor 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>
-**It may further lead to a change in staging and treatment options of the lung cancer.
+:*[[Thoracotomy]]
-**Provide guidance for the [[biopsy]].<ref name="PurandareKulkarni2013">{{cite journal|last1=Purandare|first1=Nilendu C.|last2=Kulkarni|first2=Aniruddha V.|last3=Kulkarni|first3=Suyash S.|last4=Roy|first4=Diptiman|last5=Agrawal|first5=Archi|last6=Shah|first6=Sneha|last7=Rangarajan|first7=Venkatesh|title=18F-FDG PET/CT-directed biopsy|journal=Nuclear Medicine Communications|volume=34|issue=3|year=2013|pages=203–210|issn=0143-3636|doi=10.1097/MNM.0b013e32835c5a57}}</ref>
+:*[[Thoracoscopy]]
-{| class="wikitable"
+:*[[Mediastinoscopy]]
-|[[Image:IJRI-25-109-g006.jpg|thumb|300px|Role of FDG PET/CT in primary tumor delineation. Irregular soft tissue opacity seen on coronal CT scan (arrow, A) with no obvious demarcation between the tumor and surrounding consolidation. PET/CT shows the FDG-avid tumor (arrow, B) separate from the non–FDG-avid consolidation (arrowhead, B),via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F6/><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
+::*[[Chamberlain procedure]]
-|}
+::*Left parasternal mediastinotomy
+::*[[Anterior]] mediastinotomy
+:*[[Transthoracic needle aspiration|Transthoracic]] [[percutaneous]] [[fine needle aspiration]]
+:*[[Sputum]] [[cytology]]
+::*The [[sensitivity]] or [[sputum]] [[cytology]] varies by location of the [[lung cancer]]
+*The majority of these procedures allow [[Cancer staging|staging]] of [[mediastinal]] [[lymph nodes]].
+*The table below summarizes the different types of diagnostic modalities for Pancoast tumor arranged from the most to the least [[invasive]].<ref name="staging">Lung Cancer Staging. Wikipedia.https://en.wikipedia.org/wiki/Lung_cancer_staging Accessed on March 1, 2015 </ref>
-===Molecular Test===
+{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
-Molecular tests include epidermal growth factor receptor ([[EGFR]]) mutation and [[anaplastic lymphoma kinase]] (ALK) mutation. Specific targeted agents may be administered to patients if these mutations are present.
-A transthoracic needle biopsy and a bronchoscopy are conducted to diagnose lung cancer.
-==Biopsy==
+|+
-A transthoracic needle biopsy, guided by CT or [[fluoroscopy]], is for pancoast tumors located in the periphery of the lungs since peripheral tumors are not accessible through a bronchoscope.
+|-
+! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Procedure}}
+! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Advantages}}
+! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Disadvantages}}
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Thoracotomy]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Allows the most thorough [[Inspection (medicine)|inspection]] and [[sampling]] of [[Lymph nodes|lymph node]] stations
+*May be followed by resection of [[tumor]], if feasible
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Invasive]] approach
+*Not indicated for [[Staging (pathology)|staging]] alone
+*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: #F5F5F5;" |
+*Allows evaluation of the [[aortopulmonary window]] [[lymph nodes]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*More [[invasive]]
+*[[False-negative]] rate approximately 10%
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Chamberlain procedure]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Access to station 5 ([[aortopulmonary window]] lymph node)
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Limited applications, [[invasive]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Mediastinoscopy|Cervical mediastinoscopy]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Considered the gold standard (usual comparitor)
+*Excellent for 2RL 4RL
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Invasive]]
+*Does not cover all [[mediastinal]] [[Lymph nodes|lymph node]] stations; particularly subcarinal [[lymph nodes]] (station 7), paraesophageal and [[pulmonary]] ligament [[lymph nodes]] (stations 8 and 9).
+*[[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: #F5F5F5;" |
+*Useful for the evaluation of [[inferior mediastinum]], station 5 and 6 [[lymph nodes]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Invasive]]
+*Does not cover superior [[anterior mediastinum]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Transthoracic percutaneous [[fine needle aspiration]] under CT guidance
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Widely available than some other methods
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Traverses a lot of [[lung]] [[tissue]]
+*High [[pneumothorax]] risk
+*Some [[lymph node]] stations inaccessible
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Bronchoscopy]] with blind transbronchial Wang needle
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Less [[invasive]] than above methods
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Relatively low yield
+*Not widely practiced
+*[[Bleeding]] risk
+|-
+|}
 ==References==