Non small cell lung cancer other diagnostic studies: Difference between revisions

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::*Anterior mediastinotomy  
::*Anterior mediastinotomy  
:*Transthoracic percutaneous [[fine 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 staging of mediastinal lymph nodes.  
*The majority of these procedures allow staging of mediastinal lymph nodes.  
*The table below summarizes the different types of diagnostic modalities in non small cell lung cancer arranged from the most to the least invasive.
*The table below summarizes the different types of diagnostic modalities in non small cell lung cancer arranged from the most to the least invasive.

Revision as of 17:17, 1 March 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, thoracoscopy, bronchoscopy, mediastinoscopy, transthoracic percutaneous fine needle aspiration, and sputum cytology.[1]

Other Diagnostic Studies

  • Other diagnostic modalities 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 majority of these procedures allow staging of mediastinal lymph nodes.
  • The table below summarizes 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
  • Invasive approach
  • Not indicated for staging alone
  • Significant risk of procedure-related morbidity
Left parasternal mediastinotomy (or anterior 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 (FNA) 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 FNA (Wang needle)
  • Less invasive than above methods
  • Relatively low yield
  • Not widely practiced
  • Bleeding risk

References

  1. 1.0 1.1 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.


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