Lung cancer other diagnostic studies: Difference between revisions
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{{CMG}} {{AE}} {{SH}} | {{CMG}} {{AE}} {{SH}} | ||
==Overview== | ==Overview== | ||
Other diagnostic studies include bone scintigraphy, [[PET scan]], and molecular tests. | Other [[Diagnosis|diagnostic]] studies include [[bone]] [[scintigraphy]], [[PET scan]], and [[molecular]] [[Test|tests]]. | ||
== | ==Other Diagnostic Studies== | ||
===Bone Scintigraphy=== | ===Bone Scintigraphy=== | ||
* [[Bone scan]] may demonstrate [[Metastasis|bone metastases]]. | |||
===PET scan=== | ===PET scan=== | ||
*[[Fluorodeoxyglucose|FDG]](18 F fluoro deoxyglucose) [[Positron emission tomography|PET scans]] along with [[contrast enhanced CT]] may be helpful in the | *[[Fluorodeoxyglucose|FDG]] (18 F fluoro-deoxyglucose) [[Positron emission tomography|PET scans]] along with [[contrast enhanced CT]] may be helpful in the evaluation of the extent of lung cancer. Findings on [[FDG-PET]]/[[Computed tomography|CT]] suggestive of lung cancer include:<ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref><ref name="PurandareKulkarni2013">{{cite journal|last1=Purandare|first1=Nilendu C.|last2=Kulkarni|first2=Aniruddha V.|last3=Kulkarni|first3=Suyash S.|last4=Roy|first4=Diptiman|last5=Agrawal|first5=Archi|last6=Shah|first6=Sneha|last7=Rangarajan|first7=Venkatesh|title=18F-FDG PET/CT-directed biopsy|journal=Nuclear Medicine Communications|volume=34|issue=3|year=2013|pages=203–210|issn=0143-3636|doi=10.1097/MNM.0b013e32835c5a57}}</ref> | ||
**[[Pulmonary nodule|Solitary pulmonary nodule]] | |||
{| class="wikitable" | {| class="wikitable" | ||
| | |[[Image:IJRI-25-109-g006.jpg|thumb|300px|Role of [[FDG-PET]]/[[CT]] in primary [[tumor]] delineation. Irregular [[soft tissue]] [[opacity]] seen on [[coronal]] [[Computed tomography|CT scan]] (arrow, A) with no obvious demarcation between the [[tumor]] and surrounding [[Consolidation (medicine)|consolidation]]. [[Positron emission tomography|PET]]/[[Computed tomography|CT]] shows the [[FDG]]-avid [[tumor]] (arrow, B) separate from the non–[[FDG]]-avid [[Consolidation (medicine)|consolidation]] (arrowhead, B),via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F6/><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]] | ||
|[[Image:IJRI-25-109-g008.jpg|thumb|300px|[[FDG-PET]] in [[Lymph node|nodal]] [[disease]]. Maximum intensity projection (MIP) image shows an [[FDG]]-avid primary [[lung]] [[tumor]] on the left side (arrow, A) and a focus of [[FDG]] uptake in the [[mediastinum]] (arrowhead, A). [[Computed tomography|CT scan]] shows enhancing, spiculated [[primary tumor]] (arrow, B) and a small right [[Paratracheal lymph nodes|paratracheal node]] (arrowhead, B) which is negative by size criteria. Fused [[Positron emission tomography|PET]]/[[CT]] image shows [[FDG]] concentration in the primary (arrow, C) as well as the [[Lymph node|node]] (arrowhead, C), suggesting [[Metastasis|metastatic]] involvement. [[Mediastinoscopy]] and [[biopsy]] revealed [[Metastasis|metastatic]] [[Lymph node|node]]-N3 [[disease]],via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F8/[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F9/ 9/]><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]] | |||
|- | |||
|[[Image:IJRI-25-109-g009.jpg|thumb|300px|[[FDG-PET]] in [[Lymph node|nodal]] [[disease]] [[false-positive]] study. Maximum intensity projection (MIP) image shows an [[FDG]]-avid primary [[lung]] [[tumor]] on the right side (arrow, A) and multiple foci of [[FDG]] uptake in the [[mediastinum]] (arrowhead, A). [[Computed tomography|CT scan]] shows enhancing, [[primary tumor]] (arrow, B). Fused [[Positron emission tomography|PET]]/[[Computed tomography|CT]] image shows [[FDG]] concentration in the [[Mediastinal lymph node|mediastinal nodes]], suggesting [[Metastasis|metastatic]] involvement. [[Mediastinoscopy]] and [[biopsy]] revealed [[tuberculosis]],via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F9/><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]] | |||
||[[Image:IJRI-25-109-g014.jpg|thumb|300px|[[Pleural effusion]] and role of [[FDG-PET]]/[[Computed tomography|CT]]. Enhancing lung masses seen on [[Computed tomography|CT scans]] in two different [[Patient|patients]] (arrows in A and C) with minimal [[Pleural effusion|pleural effusions]] (arrowheads in A and C). Corresponding [[Positron emission tomography|PET]]/[[Computed tomography|CT]] [[Scan|scans]] show intense [[FDG]]-avid [[Metastasis|metastatic]] [[pleural]] deposits (arrowheads in B and D) as the cause of [[Pleural effusion|effusions]]. Note that the [[pleural]] deposits are barely perceptible on [[Computed tomography|CT]], via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F14/><ref name="PurandareRangarajan20152">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>|link=https://www.wikidoc.org/index.php/File:IJRI-25-109-g011.jpg]] | |||
|- | |||
|[[Image:IJRI-25-109-g015.jpg|thumb|300px| | |||
Incremental value of [[FDG-PET]]/[[Computed tomography|CT]] in baseline [[Cancer staging|staging]]. MIP image of [[FDG-PET|FDG-PET scan]] shows intense [[tracer]] concentration in the right [[Thorax|hemithorax]] (arrow, A) corresponding to a right lung mass (arrow, B). Also seen are two [[FDG]]-avid foci in the [[abdomen]] (arrowheads, A) which correspond to [[Peritoneum|peritoneal]] [[metastatic]] deposits (arrowhead, C). Note that the [[Peritoneum|peritoneal]] deposit is almost indistinguishable from the adjacent [[Intestine|bowel]] (arrowhead, D). Due to [[Positron emission tomography|PET]]/[[Computed tomography|CT]] findings, the intent of treatment changes from [[Cure|curative]] [[surgery]] of a [[Resection|resectable]] mass to [[Palliative care|palliative]] [[chemotherapy]], via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F15/>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.<ref name="PurandareRangarajan20152">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>|link=https://www.wikidoc.org/index.php/File:IJRI-25-109-g011.jpg]] | |||
|[[Image:IJRI-25-109-g011.jpg|thumb|300px|Adrenal adenoma versus metastasis. Enhancing solid adrenal nodule on CT scan in a case of lung cancer (arrow, A) suggestive of metastatic deposit. Unenhanced CT scan shows fatty attenuation within the nodule with an HU value of 0 suggesting the possibility of an adenoma (arrow, B). FDG PET/CT shows no tracer concentration in the nodule, confirming the diagnosis of adenoma. Enhancing solid adrenal nodule on CT scan in another patient of lung cancer (arrow, D), which is indeterminate in nature. FDG PET/CT shows abnormal focal tracer concentration in the nodule (arrow, E) highly suggestive of a metastatic deposit via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F11/><ref name="PurandareRangarajan20152">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>|link=https://www.wikidoc.org/index.php/File:IJRI-25-109-g011.jpg]] | |||
|} | |} | ||
===Molecular Test=== | ===Molecular Test=== | ||
Molecular tests include epidermal growth factor receptor ([[ | |||
* [[Molecule|Molecular]] [[Test|tests]] include [[EGFR|epidermal growth factor receptor (EGFR)]] [[mutation]] and [[anaplastic lymphoma kinase|anaplastic lymphoma kinase (ALK)]] [[mutation]]. | |||
* Specific targeted agents may be administered to [[patients]] if these [[Mutation|mutations]] are present. | |||
==References== | ==References== | ||
Latest revision as of 18:08, 8 July 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]
Overview
Other diagnostic studies include bone scintigraphy, PET scan, and molecular tests.
Other Diagnostic Studies
Bone Scintigraphy
- Bone scan may demonstrate bone metastases.
PET scan
- FDG (18 F fluoro-deoxyglucose) PET scans along with contrast enhanced CT may be helpful in the evaluation of the extent of lung cancer. Findings on FDG-PET/CT suggestive of lung cancer include:[1][2]
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Molecular Test
- Molecular tests include epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) mutation.
- Specific targeted agents may be administered to patients if these mutations are present.
References
- ↑ 1.0 1.1 1.2 1.3 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.
- ↑ Purandare, Nilendu C.; Kulkarni, Aniruddha V.; Kulkarni, Suyash S.; Roy, Diptiman; Agrawal, Archi; Shah, Sneha; Rangarajan, Venkatesh (2013). "18F-FDG PET/CT-directed biopsy". Nuclear Medicine Communications. 34 (3): 203–210. doi:10.1097/MNM.0b013e32835c5a57. ISSN 0143-3636.
- ↑ 3.0 3.1 3.2 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.