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==Biopsy==
Common types of lung tissue biopsy include:<ref name="pmid12820712">{{cite journal |vauthors=Yung RC |title=Tissue diagnosis of suspected lung cancer: selecting between bronchoscopy, transthoracic needle aspiration, and resectional biopsy |journal=Respir Care Clin N Am |volume=9 |issue=1 |pages=51–76 |year=2003 |pmid=12820712 |doi= |url=}}</ref><ref name="NSCLS2">Squamous cell carcinoma of the lung. Libre Pathology http://librepathology.org/wiki/Squamous_cell_carcinoma_of_the_lung Accessed on March 1, 2016</ref>
*[[Needle biopsy]]
*Open biopsy
*Video-assisted [[Thoracoscopy|thoracoscopic]] surgery (VATS)
Indications for lung tissue biopsy in suspected non-small cell lung cancer include:<ref name="NSCLS2">Squamous cell carcinoma of the lung. Libre Pathology http://librepathology.org/wiki/Squamous_cell_carcinoma_of_the_lung Accessed on March 1, 2016</ref>
*Determination of tumor [[histologic]] subtype
*Characterization of [[genetic mutations]]
*Determination of intra or extra-thoracic metastatic disease
==Biopsy Findings==
*The table below summarizes the common types of non-small cell lung cancer biopsy findings.<ref name="NSCLS2">Squamous cell carcinoma of the lung. Libre Pathology http://librepathology.org/wiki/Squamous_cell_carcinoma_of_the_lung Accessed on March 1, 2016</ref>
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
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! style="background: #4479BA; width: 50px;" | {{fontcolor|#FFF|Type of tumor }}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Biopsy findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Lung adenocarcinoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Nuclear atypia
*Eccentrically placed nuclei
*Abundant cytoplasm - classically with mucin vacuoles
*Often conspicuous [[nucleoli]]
*[[Nuclear pseudoinclusions]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Squamous-cell cancer|Squamous cell lung carcinoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Central nucleus
*Dense appearing cytoplasm, usually eosinophilic
*Small nucleolus
*Intracellular bridges - classic
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Large cell carcinoma of the lung|Large cell lung carcinoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Large polygonal cells and anaplastic cells
*Solid nests without obvious squamous or glandular differentiation
*Moderately abundant cytoplasm                 
*Well defined cell borders                         
*Vesicular nuclei, prominent nucleoli
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Adenosquamous carcinoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Substantial amounts of squamous and glandular differentiation                                             
*Positive stains for TTF1  and p63 in squamous component
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Sarcomatoid carcinoma of the lung|Sarcomatoid carcinoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Sarcoma-like differentiation                       
*Spindle cells vary morphologically from epithelioid to strikingly spindled and are arranged in haphazard fascicles or storiform pattern                                                                         
*Moderate to abundant, dense, eosinophilic cytoplasm
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Carcinoid tumor]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Medium sized polygonal cells with lightly eosinophilic cytoplasm                                           
*Low nuclear grade, round to oval finely granular nuclei; may have rosettes or small acinar structures with variable mucin
*Scanty vascular stroma, occasionally amyloid stroma with bone
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Salivary gland tumor]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Organized in round and sometimes confluent islands, rich in matrix and with dispersed condrocyte-type cells
|-
|}
==Immunohistochemistry Stain==
'''On immunohistochemistry''', the findings depend on the histological type of non-small cell lung cancer.<ref name="pmid19466276">{{cite journal |vauthors=Capelozzi VL |title=Role of immunohistochemistry in the diagnosis of lung cancer |journal=J Bras Pneumol |volume=35 |issue=4 |pages=375–82 |year=2009 |pmid=19466276 |doi= |url=}}</ref>
*Common immunohistochemistry markers used for non-small cell carcinoma subtyping, include:
*TTF-1 for adenocarcinoma
*p63 and high-molecular-weight keratins for squamous cell carcinoma
*Lack of staining with neuroendocrine markers ([[chromogranin A]], synaptophysin, and [[CD56]])


==References==
==References==

Revision as of 21:04, 8 January 2019

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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 histopathological evaluation and immunohistochemical staining of the tumor specimen obtained from biopsy or sputum cytology. Different types of lung tissue biopsy for non-small cell lung cancer include needle biopsy, open biopsy, and video-assisted thoracoscopic surgery (VATS). Specimen for biopsy can also 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]

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

Biopsy

Common types of lung tissue biopsy include:[10][11]

Indications for lung tissue biopsy in suspected non-small cell lung cancer include:[11]

  • Determination of tumor histologic subtype
  • Characterization of genetic mutations
  • Determination of intra or extra-thoracic metastatic disease

Biopsy Findings

  • The table below summarizes the common types of non-small cell lung cancer biopsy findings.[11]
Type of tumor Biopsy findings
Lung adenocarcinoma
Squamous cell lung carcinoma
  • Central nucleus
  • Dense appearing cytoplasm, usually eosinophilic
  • Small nucleolus
  • Intracellular bridges - classic
Large cell lung carcinoma
  • Large polygonal cells and anaplastic cells
  • Solid nests without obvious squamous or glandular differentiation
  • Moderately abundant cytoplasm
  • Well defined cell borders
  • Vesicular nuclei, prominent nucleoli
Adenosquamous carcinoma
  • Substantial amounts of squamous and glandular differentiation
  • Positive stains for TTF1 and p63 in squamous component
Sarcomatoid carcinoma
  • Sarcoma-like differentiation
  • Spindle cells vary morphologically from epithelioid to strikingly spindled and are arranged in haphazard fascicles or storiform pattern
  • Moderate to abundant, dense, eosinophilic cytoplasm
Carcinoid tumor
  • Medium sized polygonal cells with lightly eosinophilic cytoplasm
  • Low nuclear grade, round to oval finely granular nuclei; may have rosettes or small acinar structures with variable mucin
  • Scanty vascular stroma, occasionally amyloid stroma with bone
Salivary gland tumor
  • Organized in round and sometimes confluent islands, rich in matrix and with dispersed condrocyte-type cells

Immunohistochemistry Stain

On immunohistochemistry, the findings depend on the histological type of non-small cell lung cancer.[12]

  • Common immunohistochemistry markers used for non-small cell carcinoma subtyping, include:
  • TTF-1 for adenocarcinoma
  • p63 and high-molecular-weight keratins for squamous cell carcinoma
  • Lack of staining with neuroendocrine markers (chromogranin A, synaptophysin, and CD56)


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.
  10. ↑ Yung RC (2003). "Tissue diagnosis of suspected lung cancer: selecting between bronchoscopy, transthoracic needle aspiration, and resectional biopsy". Respir Care Clin N Am. 9 (1): 51–76. PMID 12820712.
  11. ↑ 11.0 11.1 11.2 Squamous cell carcinoma of the lung. Libre Pathology http://librepathology.org/wiki/Squamous_cell_carcinoma_of_the_lung Accessed on March 1, 2016
  12. ↑ Capelozzi VL (2009). "Role of immunohistochemistry in the diagnosis of lung cancer". J Bras Pneumol. 35 (4): 375–82. PMID 19466276.


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