Squamous cell carcinoma of the lung other diagnostic studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

Other diagnostic modalities for squamous cell carcinoma of the lung, include: thoracotomy, thoracoscopy, bronchoscopy, mediastinoscopy, transthoracic percutaneous fine needle aspiration, and sputum cytology.

Other Diagnostic Studies

  • Other diagnostic modalities for squamous cell carcinoma of the lung include:[1]
  • Mediastinoscopy
  • Chamberlain procedure
  • Left parasternal mediastinotomy
  • Anterior mediastinotomy
  • 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.[2][3][4][5][6][7][8]
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
Anterior 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
  • 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

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. ↑ 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.
  3. ↑ Kim ES, Bosquée L (June 2007). "The importance of accurate lymph node staging in early and locally advanced non-small cell lung cancer: an update on available techniques". J Thorac Oncol. 2 Suppl 2: S59–67. doi:10.1097/01.JTO.0000269738.13586.fd. PMID 17589301.
  4. ↑ Wiersema M et al. Real-time endoscopic ultrasound-guided fine-needle aspiration of a mediastinal lymph node. Gastrointest Endosc 1993, 39(3):429-431
  5. ↑ Wallace MB, Pascual JM, Raimondo M, et al. (February 2008). "Minimally invasive endoscopic staging of suspected lung cancer". JAMA. 299 (5): 540–6. doi:10.1001/jama.299.5.540. PMID 18252884.
  6. ↑ Singh P et al. Endoscopic ultrasound as a first test for diagnosis and staging of lung cancer: a prospective study. Am J Respir Crit Care Med 2007, 175(4):345-354.
  7. ↑ Cerfolio R, Bryant A, Ojha B: Restaging patients with N2 (stage IIIa) non-small cell lung cancer after neoadjuvant chemoradiotherapy: a prospective study. J Thorac Cardiovasc Surg 2006, 131(6):1229-1235
  8. ↑ Yasufuku K et al. Endobronchial ultrasonography: current status and future directions. J Thorac Oncol 2007, 2(10):970-979.


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