Non small cell lung cancer diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2],Furqan M M. M.B.B.S[3]
Overview
Chest X-Ray is the initial study performed when non-small cell lung cancer is suspected. Lung CT scan is the diagnostic study of choice for the diagnosis of non-small cell lung cancer. Endobronchial ultrasound is a first-line diagnostic modality for the mediastinal staging of the non-small cell lung cancer. The lung biopsy is the gold standard for the diagnosis of the non-small cell lung cancer. The lung biopsy helps to differentiate between the various subtypes of lung cancer.
Diagnostic Study of Choice
Study of choice
Non small cell cancer of the lung is diagnosed by the following approach:[1]
- Chest X-Ray is the initial study performed when non-small cell lung cancer is suspected.
- The next step in diagnosing non small cell carcinoma of the lung is contrast-enhanced computed tomography.
- On CT, characteristic findings of non-small cell lung cancer include:[2]
- Centrally located tumors, invading the mediastinal structures
- Peripherally located tumors, invading the pleura and chest wall
- Tumor margins: Smooth, lobulated, irregular and spiculated
- Tumor density: Uniformly solid; central necrosis; cavitation (squamous histology)
- Area of consolidation in the pulmonary field
- Ground-glass opacity
- Air bronchogram
- When the imaging study suggests lung cancer, diagnosis must be confirmed by performing a bronchoscopic or an image-guided biopsy.
Diagnostic modality for staging
Endobronchial ultrasound is a first-line diagnostic modality for mediastinal staging.
- On ultrasound (endobronchial ultrasound), characteristic findings of non-small cell lung cancer include:
- Enlarged lymph nodes
- Local invasion of adjacent bronchial structures and mediastinum
- Indications for the endobronchial ultrasound:
- Evaluation of lymph nodes and other structures in the mediastinum
- Mediastinal invasion staging
- Determination of management strategy
- Real-time evaluation of structures
Gold standard
- Lung biopsy is the gold standard test for the diagnosis of non-small cell lung cancer.
Diagnostic results
The diagnostic result of lung biopsy is confirmatory of non-small cell lung cancer and depends on the type of cancer. Click here to view the biopsy findings of the subtypes.
Sequence of Diagnostic Studies
The sequence of the diagnostic studies depends upon the stage of cancer. Click here to view detailed sequential management of different stages.
Evaluation Algorithm for Suspected Non-Small Cell Lung Cancer
The algorithm below summarizes the initial imaging approach for patients with suspected non-small cell lung cancer.[5][6]
Imaging approach ❑ Suspected lung cancer | |||||||||||||||||||||||||||||||
| Chest X Ray normal? | |||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||
Enhanced Computed Tomography (ECT), includes: ❑ Thorax ❑ Upper Abdomen ❑ Low Neck | Manage and observe | ||||||||||||||||||||||||||||||
Imaging evaluation | |||||||||||||||||||||||||||||||
Location ❑ Central ❑ Peripheral ❑ Pleural lesion Size Lesion characteristics ❑ Margins (irregular/regular) ❑ Shape (spiculated/rounded) Presence of cavitation ❑ Yes ❑ No Type of adenopathy ❑ Hiliar ❑ Mediastinal | |||||||||||||||||||||||||||||||
Other Imaging or Diagnostic Modalities ❑ Sputum cytology ❑ Endobronchial ultrasound ❑ Endoscopic ultrasound ❑ Bronchoscopy ❑ Mediastinoscopy ❑ PET/CT | |||||||||||||||||||||||||||||||
References
- ↑ Purandare, NilenduC; Rangarajan, Venkatesh (2015). "Imaging of lung cancer: Implications on staging and management". Indian Journal of Radiology and Imaging. 25 (2): 109. doi:10.4103/0971-3026.155831. ISSN 0971-3026.
- ↑ Kundel HL (1981). "Predictive value and threshold detectability of lung tumors". Radiology. 139 (1): 25–9. doi:10.1148/radiology.139.1.7208937. PMID 7208937.
- ↑ 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.
- ↑ Tests for non-small cell lung cancer. American Cancer Society. http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-diagnosis Accessed on February 25, 2016
- ↑ Non-small cell lung cancer: Adenocarcinoma of the lung. Radiopedia.http://radiopaedia.org/articles/adenocarcinoma-of-the-lung Accessed on March 1, 2016
- ↑ WHO: Lung cancer/Tumours of the Lung. https://www.iarc.fr/en/publications/pdfs-online/pat-gen/bb10/bb10-chap1.pdf Accessed on March 1, 2016