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==Overview==
==Overview==


Other diagnostic modalities for non-small cell lung cancer include [[thoracotomy]], [[thoracoscopy]], [[bronchoscopy]], [[mediastinoscopy]], transthoracic percutaneous [[fine needle aspiration]], and sputum [[cytology]].
Other diagnostic modalities for non-small cell lung cancer include biopsy and histopathological evaluation, and immunohistochemical staining of the specimen. Specimen for biopsy can be obtained by [[thoracotomy]], [[thoracoscopy]], [[bronchoscopy]], [[mediastinoscopy]], transthoracic percutaneous [[fine needle aspiration]].  


==Other Diagnostic Studies==
==Other Diagnostic Studies==


Other diagnostic studies may help in the staging of non-small cell cancer. Otehr diagnostic studies for non-small cell lung cancer 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>
Other diagnostic studies for non-small cell lung cancer 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]]
:*[[Thoracotomy]]
:*[[Thoracoscopy]]
:*[[Thoracoscopy]]
:*[[Bronchoscopy]]
:*[[Bronchoscopy]]
::*Bronchoscopic specimens, include:
:**Bronchoscopic specimens, include:
::*Bronchial brush
:**Bronchial brush
::*Bronchial wash
:**Bronchial wash
::*[[Bronchoalveolar lavage|Bronchioloalveolar lavage]]
:**[[Bronchoalveolar lavage|Bronchioloalveolar lavage]]
::*Transbronchial fine-needle aspiration (FNA)
:**Transbronchial fine-needle aspiration (FNA)
::*Core biopsy
:**Core biopsy
 
:*[[Mediastinoscopy]]
:*[[Mediastinoscopy]]
::*Chamberlain procedure  
:**Chamberlain procedure
::*Left parasternal mediastinotomy  
:**Left parasternal mediastinotomy  
::*Anterior mediastinotomy  
:**Anterior mediastinotomy  
 
:*Transthoracic percutaneous [[fine needle aspiration]]
:*Transthoracic percutaneous [[fine needle aspiration]]
:*Sputum [[cytology]]
:*Sputum [[cytology]]
::*The sensitivity or sputum [[cytology]] varies by location of the lung cancer  
:**The sensitivity of sputum [[cytology]] varies by location of the lung cancer


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.<ref>name="AJCC4-L">AJCC Cancer Staging Manual 4th edition; Chapter 19; Lung - original pages 115-122</ref><ref>{{cite web |url=http://www.cancerstaging.org/products/csmanual4ed.pdf |title=Archived copy |accessdate=2011-05-23 |deadurl=yes |archiveurl=https://web.archive.org/web/20110928055151/http://www.cancerstaging.org/products/csmanual4ed.pdf |archivedate=2011-09-28 |df= }}</ref><ref name="AJCC4-L">AJCC Cancer Staging Manual 4th edition; Chapter 19; Lung - original pages 115-122
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.<ref>name="AJCC4-L">AJCC Cancer Staging Manual 4th edition; Chapter 19; Lung - original pages 115-122</ref><ref>{{cite web |url=http://www.cancerstaging.org/products/csmanual4ed.pdf |title=Archived copy |accessdate=2011-05-23 |deadurl=yes |archiveurl=https://web.archive.org/web/20110928055151/http://www.cancerstaging.org/products/csmanual4ed.pdf |archivedate=2011-09-28 |df= }}</ref><ref name="AJCC4-L">AJCC Cancer Staging Manual 4th edition; Chapter 19; Lung - original pages 115-122

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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 biopsy and histopathological evaluation, and immunohistochemical staining of the specimen. Specimen for biopsy can be obtained by thoracotomy, thoracoscopy, bronchoscopy, mediastinoscopy, transthoracic percutaneous fine needle aspiration.

Other Diagnostic Studies

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

  • Mediastinoscopy
    • Chamberlain procedure
    • Left parasternal mediastinotomy
    • Anterior mediastinotomy

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][6][7][8][9][9]

Procedure Advantages Limitations
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. ↑ 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. ↑ name="AJCC4-L">AJCC Cancer Staging Manual 4th edition; Chapter 19; Lung - original pages 115-122
  3. ↑ "Archived copy" (PDF). Archived from the original (PDF) on 2011-09-28. Retrieved 2011-05-23.
  4. ↑ AJCC Cancer Staging Manual 4th edition; Chapter 19; Lung - original pages 115-122 "Archived copy" (PDF). Archived from the original (PDF) on 2011-09-28. Retrieved 2011-05-23.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ Mountain, Clifton F; Herman I Libshitz; Kay E Hermes. A Handbook for Staging, Imaging, and Lymph Node Classification. Charles P Young Company.
  8. ↑ Mountain CF (June 1997). "Revisions in the International System for Staging Lung Cancer". Chest. 111 (6): 1710–7. doi:10.1378/chest.111.6.1710. PMID 9187198. Archived from the original on 2003-09-05.
  9. ↑ 9.0 9.1 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.


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