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==Overview==
==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 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==


Other diagnostic studies may help in the staging of non-small cell cancer. Otehr diagnostic studies for non-small cell lung cancer 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>
Other diagnostic studies may help in the staging of non-small cell cancer. Otehr diagnostic studies for non-small cell lung cancer 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>
:*Thoracotomy
:*[[Thoracotomy]]
:*Thoracoscopy
:*[[Thoracoscopy]]
:*Bronchoscopy
:*[[Bronchoscopy]]
::*Bronchoscopic specimens, include:
::*Bronchoscopic specimens, include:
::*Bronchial brush
::*Bronchial brush
::*Bronchial wash
::*Bronchial wash
::*Bronchioloalveolar lavage
::*[[Bronchoalveolar lavage|Bronchioloalveolar lavage]]
::*Transbronchial fine-needle aspiration (FNA)
::*Transbronchial fine-needle aspiration (FNA)
::*Core biopsy
::*Core biopsy
:*Mediastinoscopy
:*[[Mediastinoscopy]]
::*Chamberlain procedure  
::*Chamberlain procedure  
::*Left parasternal mediastinotomy  
::*Left parasternal mediastinotomy  
::*Anterior mediastinotomy  
::*Anterior mediastinotomy  
:*Transthoracic percutaneous [[fine needle aspiration]]
:*Transthoracic percutaneous [[fine needle aspiration]]
:*Sputum cytology   
:*Sputum [[cytology]]  
::*The sensitivity or sputum cytology varies by location of the lung cancer  
::*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.<ref> name="AJCC4-L">AJCC Cancer Staging Manual 4th edition; Chapter 19; Lung - original pages 115-122</ref><ref>{{cite web |url=http://www.cancerstaging.org/products/csmanual4ed.pdf |title=Archived copy |accessdate=2011-05-23 |deadurl=yes |archiveurl=https://web.archive.org/web/20110928055151/http://www.cancerstaging.org/products/csmanual4ed.pdf |archivedate=2011-09-28 |df= }}</ref><ref name="AJCC4-L">AJCC Cancer Staging Manual 4th edition; Chapter 19; Lung - original pages 115-122
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.<ref>name="AJCC4-L">AJCC Cancer Staging Manual 4th edition; Chapter 19; Lung - original pages 115-122</ref><ref>{{cite web |url=http://www.cancerstaging.org/products/csmanual4ed.pdf |title=Archived copy |accessdate=2011-05-23 |deadurl=yes |archiveurl=https://web.archive.org/web/20110928055151/http://www.cancerstaging.org/products/csmanual4ed.pdf |archivedate=2011-09-28 |df= }}</ref><ref name="AJCC4-L">AJCC Cancer Staging Manual 4th edition; Chapter 19; Lung - original pages 115-122
{{cite web |url=http://www.cancerstaging.org/products/csmanual4ed.pdf |title=Archived copy |accessdate=2011-05-23 |deadurl=yes |archiveurl=https://web.archive.org/web/20110928055151/http://www.cancerstaging.org/products/csmanual4ed.pdf |archivedate=2011-09-28 |df= }}</ref><ref name="pmid4000199">{{cite journal |vauthors=Feinstein AR, Sosin DM, Wells CK |title=The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer |journal=N. Engl. J. Med. |volume=312 |issue=25 |pages=1604–8 |date=June 1985 |pmid=4000199|doi=10.1056/NEJM198506203122504|url=}}</ref><ref name="pmid18663166">{{cite journal |vauthors=Chee KG, Nguyen DV, Brown M, Gandara DR, Wun T, Lara PN |title=Positron emission tomography and improved survival in patients with lung cancer: the Will Rogers phenomenon revisited |journal=Arch. Intern. Med. |volume=168 |issue=14 |pages=1541–9|date=July 2008|pmid=18663166 |doi=10.1001/archinte.168.14.1541 |url=}}</ref><ref>{{cite book | last =Mountain | first =Clifton F |authorlink = |author2=Herman I Libshitz |author3=Kay E Hermes  | title =A Handbook for Staging, Imaging, and Lymph Node Classification |publisher =Charles P Young Company | location = | pages = | url =http://www.ctsnet.org/book/mountain/index.html | doi = |id =  }}</ref><ref name="pmid9187198">{{cite journal |author=Mountain CF |title=Revisions in the International System for Staging Lung Cancer |journal=Chest |volume=111 |issue=6 |pages=1710–7 |date=June 1997 |pmid=9187198 |doi=10.1378/chest.111.6.1710 |url=http://www.chestjournal.org/cgi/reprint/111/6/1710 |archive-url=https://web.archive.org/web/20030905122713/http://www.chestjournal.org/cgi/reprint/111/6/1710 |dead-url=yes |archive-date=2003-09-05 }}</ref><ref name="pmid17296659">{{cite journal |vauthors=Micames CG, McCrory DC, Pavey DA, Jowell PS, Gress FG |title=Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: A systematic review and metaanalysis |journal=Chest |volume=131 |issue=2 |pages=539–48|date=February 2007 |pmid=17296659|doi=10.1378/chest.06-1437|url=http://www.chestjournal.org/cgi/content/full/131/2/539}}</ref><ref name="pmid17296659">{{cite journal |vauthors=Micames CG, McCrory DC, Pavey DA, Jowell PS, Gress FG |title=Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: A systematic review and metaanalysis |journal=Chest |volume=131 |issue=2 |pages=539–48 |date=February 2007 |pmid=17296659 |doi=10.1378/chest.06-1437 |url=}}</ref>
{{cite web |url=http://www.cancerstaging.org/products/csmanual4ed.pdf |title=Archived copy |accessdate=2011-05-23 |deadurl=yes |archiveurl=https://web.archive.org/web/20110928055151/http://www.cancerstaging.org/products/csmanual4ed.pdf |archivedate=2011-09-28 |df= }}</ref><ref name="pmid4000199">{{cite journal |vauthors=Feinstein AR, Sosin DM, Wells CK |title=The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer |journal=N. Engl. J. Med. |volume=312 |issue=25 |pages=1604–8 |date=June 1985 |pmid=4000199|doi=10.1056/NEJM198506203122504|url=}}</ref><ref name="pmid18663166">{{cite journal |vauthors=Chee KG, Nguyen DV, Brown M, Gandara DR, Wun T, Lara PN |title=Positron emission tomography and improved survival in patients with lung cancer: the Will Rogers phenomenon revisited |journal=Arch. Intern. Med. |volume=168 |issue=14 |pages=1541–9|date=July 2008|pmid=18663166 |doi=10.1001/archinte.168.14.1541 |url=}}</ref><ref>{{cite book | last =Mountain | first =Clifton F |authorlink = |author2=Herman I Libshitz |author3=Kay E Hermes  | title =A Handbook for Staging, Imaging, and Lymph Node Classification |publisher =Charles P Young Company | location = | pages = | url =http://www.ctsnet.org/book/mountain/index.html | doi = |id =  }}</ref><ref name="pmid9187198">{{cite journal |author=Mountain CF |title=Revisions in the International System for Staging Lung Cancer |journal=Chest |volume=111 |issue=6 |pages=1710–7 |date=June 1997 |pmid=9187198 |doi=10.1378/chest.111.6.1710 |url=http://www.chestjournal.org/cgi/reprint/111/6/1710 |archive-url=https://web.archive.org/web/20030905122713/http://www.chestjournal.org/cgi/reprint/111/6/1710 |dead-url=yes |archive-date=2003-09-05 }}</ref><ref name="pmid17296659">{{cite journal |vauthors=Micames CG, McCrory DC, Pavey DA, Jowell PS, Gress FG |title=Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: A systematic review and metaanalysis |journal=Chest |volume=131 |issue=2 |pages=539–48|date=February 2007 |pmid=17296659|doi=10.1378/chest.06-1437|url=http://www.chestjournal.org/cgi/content/full/131/2/539}}</ref><ref name="pmid17296659">{{cite journal |vauthors=Micames CG, McCrory DC, Pavey DA, Jowell PS, Gress FG |title=Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: A systematic review and metaanalysis |journal=Chest |volume=131 |issue=2 |pages=539–48 |date=February 2007 |pmid=17296659 |doi=10.1378/chest.06-1437 |url=}}</ref>


{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align=center
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
|valign=top|
| valign="top" |
|+
|+
|-
|-
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! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Limitations}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Limitations}}
|-
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| [[Thoracotomy]]  
| 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
*Allows the most thorough inspection and sampling of lymph node stations
*May be followed by resection of tumor, if feasible
*May be followed by resection of tumor, if feasible
|style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" |
*Invasive approach
*Invasive approach
*Not indicated for staging alone
*Not indicated for staging alone
*Significant risk of procedure-related morbidity
*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: #DCDCDC; font-weight: bold; text-align:center;" | Left parasternal mediastinotomy  
|style="padding: 5px 5px; background: #F5F5F5;"|  
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Allows evaluation of the aortopulmonary window lymph nodes
*Allows evaluation of the aortopulmonary window lymph nodes
|style="padding: 5px 5px; background: #F5F5F5;"|  
| style="padding: 5px 5px; background: #F5F5F5;" |  
*More invasive
*More invasive
*False-negative rate approximately 10%
*False-negative rate approximately 10%
|-
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| Chamberlain procedure  
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Chamberlain procedure  
|style="padding: 5px 5px; background: #F5F5F5;"|  
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Access to station 5 ([[aortopulmonary window]] lymph node)
*Access to station 5 ([[aortopulmonary window]] lymph node)
|style="padding: 5px 5px; background: #F5F5F5;"|  
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Limited applications, invasive
*Limited applications, invasive
|-
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| [[Mediastinoscopy|Cervical mediastinoscopy]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Mediastinoscopy|Cervical mediastinoscopy]]
|style="padding: 5px 5px; background: #F5F5F5;"|  
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Considered the gold standard (usual comparitor)
*Considered the gold standard (usual comparitor)
*Excellent for 2RL 4RL
*Excellent for 2RL 4RL
|style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" |
*Invasive
*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).
*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%
*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: #DCDCDC; font-weight: bold; text-align:center;" | [[Thoracoscopy|Video-assisted thoracoscopy]]
|style="padding: 5px 5px; background: #F5F5F5;"|  
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Useful for the evaluation of inferior mediastinum, station 5 and 6 lymph nodes
*Useful for the evaluation of inferior mediastinum, station 5 and 6 lymph nodes
|style="padding: 5px 5px; background: #F5F5F5;"|  
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Invasive
*Invasive
*Does not cover superior anterior mediastinum
*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: #DCDCDC; font-weight: bold; text-align:center;" | Transthoracic percutaneous [[fine needle aspiration]] under CT guidance
|style="padding: 5px 5px; background: #F5F5F5;"|  
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Widely available than some other methods
*Widely available than some other methods
|style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" |
*Traverses a lot of lung tissue
*Traverses a lot of lung tissue
*High pneumothorax risk
*High pneumothorax risk
*Some lymph node stations inaccessible
*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: #DCDCDC; font-weight: bold; text-align:center;" | [[Bronchoscopy]] with blind transbronchial Wang needle
|style="padding: 5px 5px; background: #F5F5F5;"|  
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Less invasive than above methods
*Less invasive than above methods
|style="padding: 5px 5px; background: #F5F5F5;"|  
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Relatively low yield
*Relatively low yield
*Not widely practiced
*Not widely practiced
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==References==
==References==
{{reflist|2}}
{{reflist|2}}


[[Category:Types of cancer]]
[[Category:Types of cancer]]

Revision as of 23:15, 23 February 2018

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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 diagnostic studies for non-small cell lung cancer include:[1]

  • Bronchoscopic specimens, include:
  • Bronchial brush
  • Bronchial wash
  • Bronchioloalveolar lavage
  • Transbronchial fine-needle aspiration (FNA)
  • Core biopsy
  • 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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