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==Other Diagnostic Studies==
==Other Diagnostic Studies==
*There are numerous diagnostic modalities which allow staging of mediastinal lymph nodes.  
 
*Other diagnostic modalities for non-small cell lung cancer, include:
:*Thoracotomy
:*Bronchoscopy
:*Mediastinoscopy
::*Chamberlain procedure
::*Left parasternal mediastinotomy
::*Anterior mediastinotomy
:*Transthoracic percutaneous [[fine needle aspiration]]
*The majority of these procedures allow staging of mediastinal lymph nodes.  
*The table below demonstrates the different types of diagnostic modalities in non small cell lung cancer arranged from the most to the least invasive.
*The table below demonstrates the different types of diagnostic modalities in non small cell lung cancer arranged from the most to the least invasive.


 
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! style="background: #4479BA; width: 200px;" | {{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|Disadvantages}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Disadvantages}}
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|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| Endobronchial ultrasound (EBUS)
|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, may be followed by resection of tumor, if feasible
*Direct visualization of lymph node stations.
|style="padding: 5px 5px; background: #F5F5F5;"| Most invasive approach, not indicated for staging alone, significant risk of procedure-related morbidity
*Complements endoscopic ultrasound: covers lymph node stations 2R and 4R which are difficult to access by endoscopic ultrasound
|-
*Lower false-negative rate than with blind transbronchial fine needle aspiration and fewer complications
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| Left parasternal mediastinotomy (or anterior mediastinotomy)
|style="padding: 5px 5px; background: #F5F5F5;"|
|style="padding: 5px 5px; background: #F5F5F5;"| Permits evaluation of the aortopulmonary window lymph nodes
*More invasive than endoscopic ultrasound, few practitioners, but rapidly growing in popularity
|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;"| Still considered the gold standard (usual comparitor) by many, excellent for 2RL 4RL
|style="padding: 5px 5px; background: #F5F5F5;"| Does not cover all medastinal lymph node stations, particularly subcarinal lymph nodes (station 7), paraesophageal and pulmonary ligament lymph nodes (stations 8 and 9), the aortopulmonary window lymph nodes (station 5), and the anterior mediastinal lymph nodes (station 6); false-negative rate approximately 20%; invasive
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| [[Thoracoscopy|Video-assisted thoracoscopy]]
|style="padding: 5px 5px; background: #F5F5F5;"| Good for 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]] (FNA) under CT guidance
|style="padding: 5px 5px; background: #F5F5F5;"| More widely available than some other methods
|style="padding: 5px 5px; background: #F5F5F5;"| Traverses a lot of lung tissue, therefore high pneumothorax risk, some lymph node stations inaccessible
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| [[Bronchoscopy]] with blind transbronchial FNA (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
|-
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|  [[Endoscopic ultrasound]] (EUS)
|style="padding: 5px 5px; background: #F5F5F5;"|
*Least invasive modality
*Uses the esophagus to access mediastinal lymph nodes
*Excellent for staging lymph nodes
*Useful for station 2L and 4L, L adrenal, celiac lymph node
|style="padding: 5px 5px; background: #F5F5F5;"|
*Cannot reliably access right sided paratracheal lymph node stations 2 R and 4R
*Accurate discrimination of primary hilar tumors and involved lymph nodes is important
|}
|}


Revision as of 15:31, 25 February 2016

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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, bronchoscopy, mediastinoscopy, and transthoracic percutaneous fine needle aspiration.

Other Diagnostic Studies

  • Other diagnostic modalities for non-small cell lung cancer, include:
  • Thoracotomy
  • Bronchoscopy
  • Mediastinoscopy
  • Chamberlain procedure
  • Left parasternal mediastinotomy
  • Anterior mediastinotomy
  • The majority of these procedures allow staging of mediastinal lymph nodes.
  • The table below demonstrates the different types of diagnostic modalities in non small cell lung cancer arranged from the most to the least invasive.
Procedure Advantages Disadvantages
Thoracotomy Allows the most thorough inspection and sampling of lymph node stations, may be followed by resection of tumor, if feasible Most invasive approach, not indicated for staging alone, significant risk of procedure-related morbidity
Left parasternal mediastinotomy (or anterior mediastinotomy) Permits 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 Still considered the gold standard (usual comparitor) by many, excellent for 2RL 4RL Does not cover all medastinal lymph node stations, particularly subcarinal lymph nodes (station 7), paraesophageal and pulmonary ligament lymph nodes (stations 8 and 9), the aortopulmonary window lymph nodes (station 5), and the anterior mediastinal lymph nodes (station 6); false-negative rate approximately 20%; invasive
Video-assisted thoracoscopy Good for inferior mediastinum, station 5 and 6 lymph nodes Invasive, does not cover superior anterior mediastinum
Transthoracic percutaneous fine needle aspiration (FNA) under CT guidance More widely available than some other methods Traverses a lot of lung tissue, therefore high pneumothorax risk, some lymph node stations inaccessible
Bronchoscopy with blind transbronchial FNA (Wang needle) Less invasive than above methods Relatively low yield, not widely practiced, bleeding risk

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