Non small cell lung cancer other diagnostic studies: Difference between revisions

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*There are numerous diagnostic modalities which allow staging of mediastinal lymph nodes.  
*There are numerous diagnostic modalities which allow staging of mediastinal lymph nodes.  
*The table below demonstrates the different types of diagnostic modalities in non small cell lung cancer arranged from the most to the least invasive.
*The table below demonstrates the different types of diagnostic modalities in non small cell lung cancer arranged from the most to the least invasive.


{| style="border:1px solid black; border-collapse:collapse" border="1" cellpadding="5"
{| style="border:1px solid black; border-collapse:collapse" border="1" cellpadding="5"
|-
|-
! Procedure
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Procedure}}
! Advantages
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Advantages}}
! Disadvantages
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Disadvantages}}
|-
|-
| [[Thoracotomy]] (surgical opening of the chest)
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| Endobronchial ultrasound (EBUS)
| Allows the most thorough inspection and sampling of lymph node stations, may be followed by resection of tumor, if feasible
|style="padding: 5px 5px; background: #F5F5F5;"|
| Most invasive approach, not indicated for staging alone, significant risk of procedure-related morbidity
*Direct visualization of lymph node stations.  
|-
*Complements endoscopic ultrasound: covers lymph node stations 2R and 4R which are difficult to access by endoscopic ultrasound
| Extended cervical mediastinoscopy combined with a [[Chamberlain procedure]], which is also called a left parasternal mediastinotomy, or anterior mediastinotomy
*Lower false-negative rate than with blind transbronchial fine needle aspiration and fewer complications
| Permits evaluation of the aortopulmonary window lymph nodes
|style="padding: 5px 5px; background: #F5F5F5;"|
| More invasive; false-negative rate approximately 10%.
*More invasive than endoscopic ultrasound, few practitioners, but rapidly growing in popularity
|-
| Chamberlain procedure
| Access to station 5 ([[aortopulmonary window]] lymph node)
| Limited applications, invasive.
|-
| [[Mediastinoscopy|Cervical mediastinoscopy]]
| Still considered the gold standard (usual comparitor) by many, excellent for 2RL 4RL.
| Does not cover all medastinal lymph node stations, particularly subcarinal lymph nodes (station 7), paraesophageal and pulmonary ligament lymph nodes (stations 8 and 9), the aortopulmonary window lymph nodes (station 5), and the anterior mediastinal lymph nodes (station 6); false-negative rate approximately 20%; invasive
|-
| [[Thoracoscopy|Video-assisted thoracoscopy]]
| Good for inferior mediastinum, station 5 and 6 lymph nodes
| Invasive, does not cover superior anterior mediastinum
|-
| Transthoracic percutaneous [[fine needle aspiration]] (FNA) under CT guidance
| More widely available than some other methods
| Traverses a lot of lung tissue, therefore high pneumothorax risk, some lymph node stations inaccessible
|-
| [[Bronchoscopy]] with blind transbronchial FNA (Wang needle)
| Less invasive than above methods
| Relatively low yield, not widely practiced, bleeding risk
|-
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|  [[Endoscopic ultrasound]] (EUS)
|style="padding: 5px 5px; background: #F5F5F5;"|
*Least invasive modality
*Uses the esophagus to access mediastinal lymph nodes
*Excellent for staging lymph nodes
*Useful for station 2L and 4L, L adrenal, celiac lymph node
|style="padding: 5px 5px; background: #F5F5F5;"|
*Cannot reliably access right sided paratracheal lymph node stations 2 R and 4R
*Accurate discrimination of primary hilar tumors and involved lymph nodes is important
|}
|}


Revision as of 14:58, 25 February 2016

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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 non-small cell lung cancer, include: thoracotomy, bronchoscopy, mediastinoscopy, and transthoracic percutaneous fine needle aspiration.

Other Diagnostic Studies

  • There are numerous diagnostic modalities which allow staging of mediastinal lymph nodes.
  • The table below demonstrates the different types of diagnostic modalities in non small cell lung cancer arranged from the most to the least invasive.


Procedure Advantages Disadvantages
Endobronchial ultrasound (EBUS)
  • Direct visualization of lymph node stations.
  • Complements endoscopic ultrasound: covers lymph node stations 2R and 4R which are difficult to access by endoscopic ultrasound
  • Lower false-negative rate than with blind transbronchial fine needle aspiration and fewer complications
  • More invasive than endoscopic ultrasound, few practitioners, but rapidly growing in popularity
Endoscopic ultrasound (EUS)
  • Least invasive modality
  • Uses the esophagus to access mediastinal lymph nodes
  • Excellent for staging lymph nodes
  • Useful for station 2L and 4L, L adrenal, celiac lymph node
  • Cannot reliably access right sided paratracheal lymph node stations 2 R and 4R
  • Accurate discrimination of primary hilar tumors and involved lymph nodes is important

References


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