Non small cell lung cancer diagnostic study of choice: Difference between revisions
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===Diagnostic modality for staging=== | ===Diagnostic modality for staging=== | ||
Staging of cancer and extent of metastasis can be diagnosed by various methods. | Staging of cancer and extent of metastasis can be diagnosed by various methods. | ||
* ''' | * '''Endoscopic ultrasound:''' | ||
** First-line diagnostic modality for mediastinal staging. | |||
* The sensitivity of endobronchial ultrasound.<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><ref name="cancer">Tests for non-small cell lung cancer. American Cancer Society. http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-diagnosis Accessed on February 25, 2016</ref> | ** Endobronchial and endoscopic esophageal ultrasound are mainly use to | ||
** The sensitivity of endobronchial ultrasound.<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><ref name="cancer">Tests for non-small cell lung cancer. American Cancer Society. http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-diagnosis Accessed on February 25, 2016</ref> | |||
*On ultrasound (endobronchial ultrasound), characteristic findings of non-small cell lung cancer include: | ** On ultrasound (endobronchial ultrasound), characteristic findings of non-small cell lung cancer include: | ||
**Enlarged lymph nodes | ****Enlarged lymph nodes | ||
**Local invasion of adjacent [[bronchial]] structures and [[mediastinum]] | ****Local invasion of adjacent [[bronchial]] structures and [[mediastinum]] | ||
* Indications for the endobronchial ultrasound: | * Indications for the endobronchial ultrasound: | ||
Revision as of 19:22, 8 January 2019
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Non Small Cell Lung Cancer Microchapters |
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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],Furqan M M. M.B.B.S[3]
Overview
Chest X-Ray is the initial study performed when non-small cell lung cancer is suspected. Lung CT scan is the diagnostic study of choice for the diagnosis of non-small cell lung cancer. Endobronchial ultrasound is a first-line diagnostic modality for the mediastinal staging of the non-small cell lung cancer. The lung biopsy is the gold standard for the diagnosis of the non-small cell lung cancer. The lung biopsy helps to differentiate between the various subtypes of lung cancer.
Diagnostic Study of Choice
Study of choice
Non small cell cancer of the lung is diagnosed by the following approach:[1]
- Chest X-Ray is the initial study performed when non-small cell lung cancer is suspected.
- The next step in diagnosing non small cell carcinoma of the lung is contrast-enhanced computed tomography (CT).
- On CT, characteristic findings of non-small cell lung cancer include:[2]
- Centrally located tumors, invading the mediastinal structures
- Peripherally located tumors, invading the pleura and chest wall
- Tumor margins: Smooth, lobulated, irregular and spiculated
- Tumor density: Uniformly solid; central necrosis; cavitation (squamous histology)
- Area of consolidation in the pulmonary field
- Ground-glass opacity (GGO)
- Air bronchogram
- Pleural or pericardial perfusion
- When the imaging study suggests lung cancer, diagnosis must be confirmed by performing a transthoracic, bronchoscopic or an image-guided biopsy depending upon the location of the tumor.[3]
Gold standard
- Lung biopsy is the gold standard test for the diagnosis of non-small cell lung cancer.
- The diagnostic result of lung biopsy is confirmatory of non-small cell lung cancer and depends on the type of cancer. Click here to view the biopsy findings of the subtypes.
Evaluation Algorithm for Suspected Non-Small Cell Lung Cancer
The algorithm below summarizes the initial imaging approach for patients with suspected non-small cell lung cancer.[1][4]
Imaging approach ❑ Suspected lung cancer | |||||||||||||||||||||||||||||||
| Chest X Ray normal? | |||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||
Enhanced Computed Tomography (ECT), includes: ❑ Thorax ❑ Upper Abdomen ❑ Low Neck | Manage and observe | ||||||||||||||||||||||||||||||
Imaging evaluation | |||||||||||||||||||||||||||||||
Location ❑ Central ❑ Peripheral ❑ Pleural lesion Size Lesion characteristics ❑ Margins (irregular/regular) ❑ Shape (spiculated/rounded) Presence of cavitation ❑ Yes ❑ No Type of adenopathy ❑ Hiliar ❑ Mediastinal | |||||||||||||||||||||||||||||||
Diagnostic modality for staging
Staging of cancer and extent of metastasis can be diagnosed by various methods.
- Endoscopic ultrasound:
- First-line diagnostic modality for mediastinal staging.
- Endobronchial and endoscopic esophageal ultrasound are mainly use to
- The sensitivity of endobronchial ultrasound.[3][5]
- On ultrasound (endobronchial ultrasound), characteristic findings of non-small cell lung cancer include:
- Enlarged lymph nodes
- Local invasion of adjacent bronchial structures and mediastinum
- Indications for the endobronchial ultrasound:
- Evaluation of lymph nodes and other structures in the mediastinum
- Mediastinal invasion staging
- Determination of management strategy
- Real-time evaluation of structures
Staging
- American Joint Committee on Cancer (AJCC) staging system
- International Union Against Cancer (UICC) staging system
American Joint Committee on Cancer (AJCC) Staging
- The table below summarizes the TNM staging system for the diagnosis of non-small cell lung cancer.[6]
| TNM | Description | |
|---|---|---|
| TX | The primary tumour cannot be assessed, or there are malignant cells in the sputum or bronchoalveolar lavage but not seen on imaging or bronchoscopy | |
| T0 | No evidence of primary tumor | |
| Tis | Carcinoma in situ | |
| T1 | Tumour less than 3 cm in its greatest dimension, surrounded by lung or visceral pleura and without bronchoscopic invasion into the main bronchus. | |
| T2 | A tumour with any of: More than 3 cm in greatest dimension; Extending into the main bronchus, but more than 2 cm distal to the carina; Obstructive pneumonitis, but not involving the entire lung | |
| T3 | A tumour with any of: Invasion of the chest wall, diaphragm, mediastinal pleura, or parietal pericardium; Extending into the main bronchus, within 2 cm of the carina, but not involving the carina; Obstructive pneumonitis of the entire lung | |
| T4 | A tumour with any of: Invasion of the mediastinum, heart, great vessels, trachea, oesophagus, vertebra, or carina; Separate tumour nodules in the same lobe; Malignant pleural effusion | |
| Regional Lymph Nodes | ||
| NX | Lymph nodes cannot be assessed | |
| N0 | No lymph nodes involved | |
| N1 | Metastasis to ipsilateral peribronchial or ipsilateral hilar lymph nodes | |
| N2 | Metastasis to ipsilateral mediastinal or subcarinal lymph nodes | |
| N3 | Metastasis to any of: Ipsilateral supraclavicular lymph nodes; Ipsilateral scalene lymph nodes; Contralateral lymph nodes. | |
| Distant Metastasis | ||
| MX | Distant metastasis cannot be assessed | |
| M0 | No distant metastasis | |
| M1 | Distant metastasis is present | |
International Union Against Cancer (UICC) Staging System
- The table below summarizes the TNM staging system for the diagnosis of non-small cell lung cancer.[6]
| Stage | T | N | M |
|---|---|---|---|
| Occult carcinoma | TX | N0 | M0 |
| Stage 0 | Tis | N0 | M0 |
| Stage IA | T1 | N0 | M0 |
| Stage IB | T2 | N0 | M0 |
| Stage IIA | T1 | N1 | M0 |
| Stage IIB | T2 | N1 | M0 |
| T3 | N0 | M0 | |
| Stage IIIA | T1 | N2 | M0 |
| T2 | N2 | M0 | |
| T3 | N1 | M0 | |
| T3 | N2 | M0 | |
| Stage IIIB | Any T | N3 | M0 |
| T4 | Any N | M0 | |
| Stage IV | Any T | Any N | M1 |
References
- ↑ 1.0 1.1 Purandare, NilenduC; Rangarajan, Venkatesh (2015). "Imaging of lung cancer: Implications on staging and management". Indian Journal of Radiology and Imaging. 25 (2): 109. doi:10.4103/0971-3026.155831. ISSN 0971-3026.
- ↑ Kundel HL (1981). "Predictive value and threshold detectability of lung tumors". Radiology. 139 (1): 25–9. doi:10.1148/radiology.139.1.7208937. PMID 7208937.
- ↑ 3.0 3.1 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.
- ↑ WHO: Lung cancer/Tumours of the Lung. https://www.iarc.fr/en/publications/pdfs-online/pat-gen/bb10/bb10-chap1.pdf Accessed on March 1, 2016
- ↑ Tests for non-small cell lung cancer. American Cancer Society. http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-diagnosis Accessed on February 25, 2016
- ↑ 6.0 6.1 6.2 Stages of non–small cell lung cancer. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/lung/staging/?region=ab
- ↑ Horn, Leora, et al. "Neoplasms of the Lung." Harrison's Principles of Internal Medicine, 19e. Eds. Dennis Kasper, et al. New York, NY: McGraw-Hill, 2015. n. pag. AccessMedicine. Web. 1 Mar. 2016. <http://accessmedicine.mhmedical.com.ezp-prod1.hul.harvard.edu/content.aspx?bookid=1130&Sectionid=69857702>.