Non small cell lung cancer other diagnostic studies

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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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