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===Biopsy===
===Biopsy===
A transthoracic needle biopsy, guided by CT or [[fluoroscopy]], is for pancoast tumors located in the periphery of the lungs since peripheral tumors are not accessible through a bronchoscope.
A transthoracic needle biopsy, guided by CT or [[fluoroscopy]], is for pancoast tumors located in the periphery of the lungs since peripheral tumors are not accessible through a bronchoscope.<ref name="pmid24484269">{{cite journal |vauthors=Kinsey CM, Arenberg DA |title=Endobronchial ultrasound-guided transbronchial needle aspiration for non-small cell lung cancer staging |journal=Am. J. Respir. Crit. Care Med. |volume=189 |issue=6 |pages=640–9 |year=2014 |pmid=24484269 |doi=10.1164/rccm.201311-2007CI |url=}}</ref>
 
*Other diagnostic modalities for pancoast tumor include :<ref name="pmid24484269">{{cite journal |vauthors=Kinsey CM, Arenberg DA |title=Endobronchial ultrasound-guided transbronchial needle aspiration for non-small cell lung cancer staging |journal=Am. J. Respir. Crit. Care Med. |volume=189 |issue=6 |pages=640–9 |year=2014 |pmid=24484269 |doi=10.1164/rccm.201311-2007CI |url=}}</ref>
:*Thoracotomy
:*Thoracoscopy
:*Mediastinoscopy
::*Chamberlain procedure
::*Left parasternal mediastinotomy
::*Anterior mediastinotomy
:*Transthoracic percutaneous [[fine needle aspiration]]
:*Sputum cytology 
::*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.<ref name="staging"> Lung Cancer Staging. Wikipedia.https://en.wikipedia.org/wiki/Lung_cancer_staging Accessed on March 1, 2015 </ref>
 
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align=center
|valign=top|
|+
|-
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Procedure}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Advantages}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Disadvantages}}
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| [[Thoracotomy]]
|style="padding: 5px 5px; background: #F5F5F5;"|
*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;"|
*Invasive approach
*Not indicated for staging alone
*Significant risk of procedure-related morbidity
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| Left parasternal mediastinotomy
|style="padding: 5px 5px; background: #F5F5F5;"|
*Allows evaluation of the aortopulmonary window lymph nodes
|style="padding: 5px 5px; background: #F5F5F5;"|
*More invasive
*False-negative rate approximately 10%
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| Chamberlain procedure
|style="padding: 5px 5px; background: #F5F5F5;"|
*Access to station 5 ([[aortopulmonary window]] lymph node)
|style="padding: 5px 5px; background: #F5F5F5;"|
*Limited applications, invasive
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| [[Mediastinoscopy|Cervical mediastinoscopy]]
|style="padding: 5px 5px; background: #F5F5F5;"|
*Considered the gold standard (usual comparitor)
*Excellent for 2RL 4RL
|style="padding: 5px 5px; background: #F5F5F5;"|
*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%
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| [[Thoracoscopy|Video-assisted thoracoscopy]]
|style="padding: 5px 5px; background: #F5F5F5;"|
*Useful for the evaluation of inferior mediastinum, station 5 and 6 lymph nodes
|style="padding: 5px 5px; background: #F5F5F5;"|
*Invasive
*Does not cover superior anterior mediastinum
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| Transthoracic percutaneous [[fine needle aspiration]] under CT guidance
|style="padding: 5px 5px; background: #F5F5F5;"|
*Widely available than some other methods
|style="padding: 5px 5px; background: #F5F5F5;"|
*Traverses a lot of lung tissue
*High pneumothorax risk
*Some lymph node stations inaccessible
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| [[Bronchoscopy]] with blind transbronchial Wang needle
|style="padding: 5px 5px; background: #F5F5F5;"|
*Less invasive than above methods
|style="padding: 5px 5px; background: #F5F5F5;"|
*Relatively low yield
*Not widely practiced
*Bleeding risk
|-
|}


==References==
==References==

Revision as of 14:14, 23 February 2018


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mazia Fatima, MBBS [2]

Overveiw

Other diagnostic studies for evaluating the spread of Pancoast tumor include bone scintigraphy, PET scan, molecular tests and biopsy.

Other Diagnostic Studies

Other diagnostic studies for evaluating the spread of Pancoast tumor include pulmonary angiography, molecular tests and biopsy.

Pulmonary Angiography

  • On pulmonary angiography, findings of Pancoast tumor may be used for:[1]
  • Evaluation of central pulmonary artery invasion

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. A transthoracic needle biopsy and a bronchoscopy are conducted to diagnose lung cancer.

Biopsy

A transthoracic needle biopsy, guided by CT or fluoroscopy, is for pancoast tumors located in the periphery of the lungs since peripheral tumors are not accessible through a bronchoscope.[2]

  • Other diagnostic modalities for pancoast tumor include :[2]
  • Thoracotomy
  • Thoracoscopy
  • 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.[3]
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
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
  • 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. ↑ Delarue NC, Sanders DE, Silverberg SA (1970). "Complementary value of pulmonary angiography and mediastinoscopy in individualizing treatment for patients with lung cancer". Cancer. 26 (6): 1370–8. PMID 5483666.
  2. ↑ 2.0 2.1 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.
  3. ↑ Lung Cancer Staging. Wikipedia.https://en.wikipedia.org/wiki/Lung_cancer_staging Accessed on March 1, 2015

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