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

• Other diagnostic modalities for non-small cell lung cancer, include:

• 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

• The majority of these procedures allow staging of mediastinal lymph nodes.
• The table below summarizes 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	Invasive approach Not indicated for staging alone Significant risk of procedure-related morbidity
Left parasternal mediastinotomy (or anterior 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 (FNA) 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 FNA (Wang needle)	Less invasive than above methods	Relatively low yield Not widely practiced Bleeding risk

References

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