Lung mass diagnostic study of choice

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Diagnostic Study of Choice
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Imaging of Lung Mass
History and Symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]Maria Fernanda Villarreal, M.D. [3]

Overview

Lung biopsy is the gold standard test for the diagnosis of lung mass. However, in order to determine the extent of invasion and to derive therapy, other investigative modalities such as CT scan, sputum cytology and PET scan are also necessary. According to the American Joint Committee on Cancer (AJCC) staging system, there are 4 stages of malignant lung mass based on 3 factors: tumor size, lymph node invasion, and metastasis. Each stage is assigned a letter and a number that designate T for tumor size, N for node invasion, and M for metastasis.

Diagnostic Study of Choice

Study of Choice

• Lung biopsy is the gold standard test for the diagnosis of lung mass. However, in order to determine the extent of invasion and to derive therapy, other investigative modalities are also necessary.

• A multidisciplinary approach is required to correctly identify the sub-type of lung mass and its staging.
• In general, diagnosis of lung mass is supplemented by the presence of clinical, radiological and pathological evidence.
• The mode of taking biopsy also depends upon the age and condition of patient. These include:
  • Ultrasound guided bronchial washings/brushings and aspiration.
  • Bronchoscopy or CT-guided biopsy.
  • Unreachable lesions are evaluated with video-assisted thoracoscopic surgery.
  • Frozen sections in case of patients already undergoing surgery for a secondary condition.

Lung Mass Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Causes
Differentiating Lung Mass from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Diagnosis
Diagnostic Study of Choice
Evaluation of Lung Mass
Imaging of Lung Mass
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Lung mass diagnostic study of choice On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Lung mass diagnostic study of choice All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Lung mass diagnostic study of choice
CDC on Lung mass diagnostic study of choice
Lung mass diagnostic study of choice in the news
Blogs on Lung mass diagnostic study of choice
Directions to Hospitals Treating bone or soft tissue mass
Risk calculators and risk factors for Lung mass diagnostic study of choice

Staging

The following table depicts the TNM classification of lung cancer:

T: Primary tumor TX Any of: Primary tumor cannot be assessed Tumor cells present in sputum or bronchial washing, but tumor not seen on imaging or bronchoscopy T0 No evidence of primary tumor Tis Carcinoma in situ T1 Tumor size less than or equal to 3 cm across, surrounded by lung or visceral pleura, without invasion proximal to the lobar bronchus T1a Tumor size less than or equal to 2 cm across T1b Tumor size more than 2 cm but less than or equal to 3 cm across T2 Any of: Tumor size more than 3 cm but less than or equal to 7 cm across Involvement of the main bronchus at least 2 cm distal to the carina Invasion of visceral pleura Atelectasis/obstructive pneumonitis extending to the hilum but not involving the whole lung T2a Tumor size more than 3 cm but less than or equal to 5 cm across T2b Tumor size more than 5 cm but less than or equal to 7 cm across T3 Any of: Tumor size more than 7 cm across Invasion into the chest wall, diaphragm, phrenic nerve, mediastinal pleura or parietal pericardium Tumor less than 2 cm distal to the carina, but not involving the carina Atelectasis/obstructive pneumonitis of the whole lung Separate tumor nodule in the same lobe T4 Any of: Invasion of the mediastinum, heart, great vessels, trachea, carina, recurrent laryngeal nerve, esophagus, or vertebra Separate tumor nodule in a different lobe of the same lung

N: Lymph nodes NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Metastasis to ipsilateral peribronchial and/or hilar lymph nodes N2 Metastasis to ipsilateral mediastinal and/or sub-carinal lymph nodes N3 Any of: Metastasis to scalene or supraclavicular lymph nodes Metastasis to contralateral hilar or mediastinal lymph nodes

M: Metastasis MX Distant metastasis cannot be assessed M0 No distant metastasis M1a Any of: Separate tumor nodule in the other lung Tumor with pleural nodules Malignant pleural or pericardial effusion M1b Distant metastasis