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

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Revision as of 21:10, 8 January 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

Diagnosis of non-small cell lung cancer can be confirmed by histopathological evaluation and immunohistochemical staining of the tumor specimen obtained from biopsy. Different types of lung tissue biopsy for non-small cell lung cancer include transthoracic needle biopsy, open biopsy, and video-assisted thoracoscopic surgery (VATS). Specimen for histopathological evaluation and immunohistochemical staining can also be obtained by bronchoscopy, mediastinoscopy, transthoracic percutaneous fine needle aspiration or sputum cytology.

Other Diagnostic Studies

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

Thoracotomy
Thoracoscopy
Bronchoscopy
- Bronchoscopic specimens, include:
- Bronchial brush
- Bronchial wash
- Bronchioloalveolar lavage
- Transbronchial fine-needle aspiration (FNA)
- Core biopsy

Mediastinoscopy
- Chamberlain procedure
- Left parasternal mediastinotomy
- Anterior mediastinotomy
Transthoracic percutaneous fine needle aspiration
Sputum cytology
- 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.^[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	Access to station 5 (aortopulmonary window lymph node)	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]

Needle biopsy
Open biopsy
Video-assisted thoracoscopic surgery (VATS)

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	Nuclear atypia Eccentrically placed nuclei Abundant cytoplasm - classically with mucin vacuoles Often conspicuous nucleoli Nuclear pseudoinclusions
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

↑ 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.
↑ name="AJCC4-L">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.
↑ 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.
↑ 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.
↑ 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.
↑ Mountain, Clifton F; Herman I Libshitz; Kay E Hermes. A Handbook for Staging, Imaging, and Lymph Node Classification. Charles P Young Company.
↑ 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.
↑ ^9.0 ^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.
↑ 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.
↑ ^11.0 ^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
↑ Capelozzi VL (2009). "Role of immunohistochemistry in the diagnosis of lung cancer". J Bras Pneumol. 35 (4): 375–82. PMID 19466276.

Template:WikiDoc Sources

[pmid24484269-1] 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] ="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.

[AJCC4-L-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.

[pmid4000199-5] 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.

[pmid18663166-6] 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.

[pmid9187198-8] 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.

[pmid17296659-9] 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.

[pmid12820712-10] 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.

[NSCLS2-11] 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

[pmid19466276-12] 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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 ==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 [[Thoracoscopy|thoracoscopic]] surgery (VATS). Specimen for biopsy can also be obtained by [[thoracotomy]], [[thoracoscopy]], [[bronchoscopy]], [[mediastinoscopy]], transthoracic percutaneous [[fine needle aspiration]].
+Diagnosis of non-small cell lung cancer can be confirmed by histopathological evaluation and immunohistochemical staining of the tumor specimen obtained from biopsy. Different types of lung tissue biopsy for non-small cell lung cancer include transthoracic needle biopsy, [[Thoracotomy|open biopsy]], and [[Thoracoscopy|video-assisted thoracoscopic surgery (VATS)]]. Specimen for histopathological evaluation and immunohistochemical staining can also be obtained by [[bronchoscopy]], [[mediastinoscopy]], transthoracic percutaneous [[fine needle aspiration]] or sputum cytology.
 ==Other Diagnostic Studies==