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 pulmonary angiography, molecular tests, and biopsy.

Other diagnostic studies for evaluating the spread of Pancoast tumor include pulmonary angiography, molecular tests, and 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.^[2]^[3]

The majority of these procedures allow staging of mediastinal lymph nodes.
The table below summarizes the different types of diagnostic modalities for Pancoast tumor arranged from the most to the least invasive.^[4]


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

↑ Delarue NC, Sanders DE, Silverberg SA (1970). "Complementary value of pulmonary angiography and mediastinoscopy in individualizing treatment for patients with lung cancer". Cancer. 26 (6): 1370–8. PMID 5483666.
↑ ^2.0 ^2.1 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.<ref name="pmid12820712">Yung RC (2003). "Tissue diagnosis of suspected lung cancer: selecting between bronchoscopy, transthoracic needle aspiration, and resectional biopsy". Respir Care Clin N Am. 9 (1): 51–76. PMID 12820712.
↑ Squamous cell carcinoma of the lung. Libre Pathology http://librepathology.org/wiki/Squamous_cell_carcinoma_of_the_lung Accessed on March 1, 2016
↑ Lung Cancer Staging. Wikipedia.https://en.wikipedia.org/wiki/Lung_cancer_staging Accessed on March 1, 2015