Non small cell lung cancer other diagnostic studies: Difference between revisions
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==Other Diagnostic Studies== | ==Other Diagnostic Studies== | ||
* | |||
*Other diagnostic modalities for non-small cell lung cancer, include: | |||
:*Thoracotomy | |||
:*Bronchoscopy | |||
:*Mediastinoscopy | |||
::*Chamberlain procedure | |||
::*Left parasternal mediastinotomy | |||
::*Anterior mediastinotomy | |||
:*Transthoracic percutaneous [[fine needle aspiration]] | |||
*The majority of these procedures 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. | *The table below demonstrates the different types of diagnostic modalities in non small cell lung cancer arranged from the most to the least invasive. | ||
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! style="background: #4479BA; width: | ! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Procedure}} | ||
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Advantages}} | ! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Advantages}} | ||
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Disadvantages}} | ! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Disadvantages}} | ||
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|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| | |style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| [[Thoracotomy]] | ||
|style="padding: 5px 5px; background: #F5F5F5;"| | |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;"| Most 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 (or anterior mediastinotomy) | |||
|style="padding: 5px 5px; background: #F5F5F5;"| | |style="padding: 5px 5px; background: #F5F5F5;"| Permits 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;"| Still considered the gold standard (usual comparitor) by many, excellent for 2RL 4RL | |||
|style="padding: 5px 5px; background: #F5F5F5;"| 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 | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| [[Thoracoscopy|Video-assisted thoracoscopy]] | |||
|style="padding: 5px 5px; background: #F5F5F5;"| Good for 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]] (FNA) under CT guidance | |||
|style="padding: 5px 5px; background: #F5F5F5;"| More widely available than some other methods | |||
|style="padding: 5px 5px; background: #F5F5F5;"| Traverses a lot of lung tissue, therefore high pneumothorax risk, some lymph node stations inaccessible | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| [[Bronchoscopy]] with blind transbronchial FNA (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 | |||
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Revision as of 15:31, 25 February 2016
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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
- Other diagnostic modalities for non-small cell lung cancer, include:
- Thoracotomy
- Bronchoscopy
- Mediastinoscopy
- Chamberlain procedure
- Left parasternal mediastinotomy
- Anterior mediastinotomy
- Transthoracic percutaneous fine needle aspiration
- The majority of these procedures 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 | 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 |
| 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 |