Pancoast tumor other diagnostic studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mazia Fatima, MBBS [2]

Overveiw

Other diagnostic studies for evaluating the spread of Pancoast tumor include bone scintigraphy, PET scan, molecular tests and biopsy.

Other Diagnostic Studies

Other diagnostic studies for evaluating the spread of Pancoast tumor include pulmonary angiography, molecular tests and biopsy.

Pulmonary Angiography

• On pulmonary angiography, findings of Pancoast tumor may be used for:

• Evaluation of central pulmonary artery invasion

Molecular Test

Molecular tests include epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) mutation. Specific targeted agents may be administered to patients if these mutations are present. A transthoracic needle biopsy and a bronchoscopy are conducted to diagnose lung cancer.

Biopsy

A transthoracic needle biopsy, guided by CT or fluoroscopy, is for pancoast tumors located in the periphery of the lungs since peripheral tumors are not accessible through a bronchoscope.

• Other diagnostic modalities for pancoast tumor include :

• Thoracotomy
• Thoracoscopy
• Mediastinoscopy

• Chamberlain procedure
• Left parasternal mediastinotomy
• Anterior mediastinotomy

• 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 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	Allows 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	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