Non small cell lung cancer other diagnostic studies

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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
Thoracotomy (surgical opening of the chest)	Allows the most thorough inspection and sampling of lymph node stations, may be followed by resection of tumor, if feasible	Most invasive approach, not indicated for staging alone, significant risk of procedure-related morbidity
Extended cervical mediastinoscopy combined with a Chamberlain procedure, which is also called a left parasternal mediastinotomy, or anterior mediastinotomy	Permits 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	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
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

References

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