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: Trusha Tank, M.D.[2],Maria Fernanda Villarreal, M.D. [3]

Overview

Diagnosis of non-small cell lung cancer can be confirmed by histopathological evaluation and immunohistochemical staining of the tumor specimen obtained from biopsy. Different types of lung tissue biopsy for non-small cell lung cancer include transthoracic needle biopsy, open biopsy, and video-assisted thoracoscopic surgery (VATS). Specimen for histopathological evaluation and immunohistochemical staining can also be obtained by bronchoscopy, mediastinoscopy, transthoracic percutaneous fine needle aspiration or sputum cytology.

Other Diagnostic Studies

Other diagnostic studies for non-small cell lung cancer include:[1]

The table below summarizes the advantages and limitations of different types of diagnostic modalities in non-small cell lung cancer arranged from the most to the least invasive.[2][3][4][5]

Procedure Advantages Limitations
Thoracotomy
  • Allows the most thorough inspection and sampling of lymph node stations
  • May be followed by resection of he 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
  • Limited applications, invasive
Cervical mediastinoscopy
  • Considered the gold standard (usual comparitor)
  • Excellent for 2RL 4RL
Video-assisted thoracoscopy
Transthoracic percutaneous fine needle aspiration under CT guidance[6]
  • 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

Biopsy

Common types of lung tissue biopsy include:[7][8]

Indications for lung tissue biopsy in suspected non-small cell lung cancer include:[8]

  • Determination of tumor histologic subtype
  • Characterization of genetic mutations
  • Determination of intra or extra-thoracic metastatic disease

Biopsy Findings

  • The table below summarizes the common types of non-small cell lung cancer biopsy findings.
Type of tumor Biopsy findings
Lung adenocarcinoma[9]
Squamous cell lung carcinoma[10]
  • Central nucleus
  • Dense appearing cytoplasm, usually eosinophilic
  • Small nucleolus
  • Intracellular bridges - classic
Large cell lung carcinoma[11]
Adenosquamous carcinoma[12]
  • Substantial amounts of squamous and glandular differentiation
  • Positive stains for TTF1 and p63 in squamous component
Sarcomatoid carcinoma[13]
  • Sarcoma-like differentiation
  • Spindle cells vary morphologically from epithelioid to strikingly spindled and are arranged in haphazard fascicles or storiform pattern
  • Moderate to abundant, dense, eosinophilic cytoplasm
Carcinoid tumor[14]
  • Medium sized polygonal cells with lightly eosinophilic cytoplasm
  • Low nuclear grade, round to oval finely granular nuclei; may have rosettes or small acinar structures with variable mucin
  • Scanty vascular stroma, occasionally amyloid stroma with bone
Salivary gland tumor[15]
  • Organized in round and sometimes confluent islands, rich in matrix and with dispersed condrocyte-type cells

Immunohistochemistry Stain

On immunohistochemistry, the findings depend on the histological type of non-small cell lung cancer.[16]

  • Common immunohistochemistry markers used for non-small cell carcinoma subtyping, include:
  • TTF-1 for adenocarcinoma
  • p63 and high-molecular-weight keratins for squamous cell carcinoma
  • Lack of staining with neuroendocrine markers (chromogranin A, synaptophysin, and CD56)


References

  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.
  2. ↑ Feinstein AR, Sosin DM, Wells CK (June 1985). "The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer". N. Engl. J. Med. 312 (25): 1604–8. doi:10.1056/NEJM198506203122504. PMID 4000199.
  3. ↑ Chee KG, Nguyen DV, Brown M, Gandara DR, Wun T, Lara PN (July 2008). "Positron emission tomography and improved survival in patients with lung cancer: the Will Rogers phenomenon revisited". Arch. Intern. Med. 168 (14): 1541–9. doi:10.1001/archinte.168.14.1541. PMID 18663166.
  4. ↑ "www.lung.org".
  5. ↑ "Lung Cancer 101 | Lungcancer.org".
  6. ↑ Micames CG, McCrory DC, Pavey DA, Jowell PS, Gress FG (February 2007). "Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: A systematic review and metaanalysis". Chest. 131 (2): 539–48. doi:10.1378/chest.06-1437. PMID 17296659.
  7. ↑ 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.
  8. ↑ 8.0 8.1 Squamous cell carcinoma of the lung. Libre Pathology http://librepathology.org/wiki/Squamous_cell_carcinoma_of_the_lung Accessed on March 1, 2016
  9. ↑ Thunnissen E (December 2012). "Pulmonary adenocarcinoma histology". Transl Lung Cancer Res. 1 (4): 276–9. doi:10.3978/j.issn.2218-6751.2012.10.11. PMC 4367552. PMID 25806193.
  10. ↑ Suarez E, Knollmann-Ritschel B (2017). "Squamous Cell Carcinoma of the Lung". Acad Pathol. 4: 2374289517705950. doi:10.1177/2374289517705950. PMC 5528918. PMID 28815199. Vancouver style error: initials (help)
  11. ↑ Miller YE (September 2005). "Pathogenesis of lung cancer: 100 year report". Am. J. Respir. Cell Mol. Biol. 33 (3): 216–23. doi:10.1165/rcmb.2005-0158OE. PMC 2715312. PMID 16107574.
  12. ↑ Miller YE (2005). "Pathogenesis of lung cancer: 100 year report". Am. J. Respir. Cell Mol. Biol. 33 (3): 216–23. doi:10.1165/rcmb.2005-0158OE. PMC 2715312. PMID 16107574.
  13. ↑ Hountis P, Moraitis S, Dedeilias P, Ikonomidis P, Douzinas M (June 2009). "Sarcomatoid lung carcinomas: a case series". Cases J. 2: 7900. doi:10.4076/1757-1626-2-7900. PMC 2740247. PMID 19830024.
  14. ↑ Reid MD, Bagci P, Ohike N, Saka B, Erbarut Seven I, Dursun N, Balci S, Gucer H, Jang KT, Tajiri T, Basturk O, Kong SY, Goodman M, Akkas G, Adsay V (May 2015). "Calculation of the Ki67 index in pancreatic neuroendocrine tumors: a comparative analysis of four counting methodologies". Mod. Pathol. 28 (5): 686–94. doi:10.1038/modpathol.2014.156. PMC 4460192. PMID 25412850.
  15. ↑ Marco Guzzo, Laura D. Locati, Franz J. Prott, Gemma Gatta, Mark McGurk & Lisa Licitra (2010). "Major and minor salivary gland tumors". Critical reviews in oncology/hematology. 74 (2): 134–148. doi:10.1016/j.critrevonc.2009.10.004. PMID 019939701. Unknown parameter |month= ignored (help)
  16. ↑ Capelozzi VL (2009). "Role of immunohistochemistry in the diagnosis of lung cancer". J Bras Pneumol. 35 (4): 375–82. PMID 19466276.


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