Lung cancer other diagnostic studies: Difference between revisions

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Revision as of 16:39, 16 February 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]

Overview

Other diagnostic studies include bone scintigraphy, PET scan, and molecular tests.

Lung Cancer Other Diagnostic Studies

Bone Scintigraphy

A bone scan may demonstrate bone metastases.

PET scan

FDG(18 F fluoro deoxyglucose) PET scans along with contrast enhanced CT may be helpful in the diagnosis of extent of lung cancer. Findings on FDGPET/CT suggestive of lung cancer include:^[1]
- Solitary pulmonary nodule
Benefits of FDGPET/CT include:^[2]
- Accurate delineation of the viable tumor from surrounding atelectasis and collapse or consolidation.
- It may further lead to a change in staging of the lung cancer.
- Provide guidance for the biopsy.^[3]

Role of FDG PET/CT in primary tumor delineation. Irregular soft tissue opacity seen on coronal CT scan (arrow, A) with no obvious demarcation between the tumor and surrounding consolidation. PET/CT shows the FDG-avid tumor (arrow, B) separate from the non–FDG-avid consolidation (arrowhead, B),via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F6/>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.^[1]	FDG PET in nodal disease. Maximum intensity projection (MIP) image shows an FDG-avid primary lung tumor on the left side (arrow, A) and a focus of FDG uptake in the mediastinum (arrowhead, A). CT scan shows enhancing, spiculated primary tumor (arrow, B) and a small right paratracheal node (arrowhead, B) which is negative by size criteria. Fused PET/CT image shows FDG concentration in the primary (arrow, C) as well as the node (arrowhead, C), suggesting metastatic involvement. Mediastinoscopy and biospy revealed metastatic node-N3 disease,via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F8/9/>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.^[1]
FDG PET in nodal disease false-positive study. Maximum intensity projection (MIP) image shows an FDG-avid primary lung tumor on the right side (arrow, A) and multiple foci of FDG uptake in the mediastinum (arrowhead, A). CT scan shows enhancing, primary tumor (arrow, B). Fused PET/CT image shows FDG concentration in the mediastinal nodes, suggesting metastatic involvement. Mediastinoscopy and biospy revealed tuberculosis,via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F9/>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.^[1]	Adrenal adenoma versus metastasis. Enhancing solid adrenal nodule on CT scan in a case of lung cancer (arrow, A) suggestive of metastatic deposit. Unenhanced CT scan shows fatty attenuation within the nodule with an HU value of 0 suggesting the possibility of an adenoma (arrow, B). FDG PET/CT shows no tracer concentration in the nodule, confirming the diagnosis of adenoma. Enhancing solid adrenal nodule on CT scan in another patient of lung cancer (arrow, D), which is indeterminate in nature. FDG PET/CT shows abnormal focal tracer concentration in the nodule (arrow, E) highly suggestive of a metastatic deposit via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F11/>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.^[4]

Molecular Test

Molecular tests include epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) mutation. Specific targeted agents may be administered to patients if these mutations are present.

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 Purandare, NilenduC; Rangarajan, Venkatesh (2015). "Imaging of lung cancer: Implications on staging and management". Indian Journal of Radiology and Imaging. 25 (2): 109. doi:10.4103/0971-3026.155831. ISSN 0971-3026.
↑ van Baardwijk, Angela; Baumert, Brigitta G.; Bosmans, Geert; van Kroonenburgh, Marinus; Stroobants, Sigrid; Gregoire, Vincent; Lambin, Philippe; De Ruysscher, Dirk (2006). "The current status of FDG–PET in tumour volume definition in radiotherapy treatment planning". Cancer Treatment Reviews. 32 (4): 245–260. doi:10.1016/j.ctrv.2006.02.002. ISSN 0305-7372.
↑ Purandare, Nilendu C.; Kulkarni, Aniruddha V.; Kulkarni, Suyash S.; Roy, Diptiman; Agrawal, Archi; Shah, Sneha; Rangarajan, Venkatesh (2013). "18F-FDG PET/CT-directed biopsy". Nuclear Medicine Communications. 34 (3): 203–210. doi:10.1097/MNM.0b013e32835c5a57. ISSN 0143-3636.
↑ Purandare, NilenduC; Rangarajan, Venkatesh (2015). "Imaging of lung cancer: Implications on staging and management". Indian Journal of Radiology and Imaging. 25 (2): 109. doi:10.4103/0971-3026.155831. ISSN 0971-3026.

Template:WikiDoc Sources

[PurandareRangarajan2015-1] 1.0 ^1.1 ^1.2 ^1.3 Purandare, NilenduC; Rangarajan, Venkatesh (2015). "Imaging of lung cancer: Implications on staging and management". Indian Journal of Radiology and Imaging. 25 (2): 109. doi:10.4103/0971-3026.155831. ISSN 0971-3026.

[van_BaardwijkBaumert2006-2] van Baardwijk, Angela; Baumert, Brigitta G.; Bosmans, Geert; van Kroonenburgh, Marinus; Stroobants, Sigrid; Gregoire, Vincent; Lambin, Philippe; De Ruysscher, Dirk (2006). "The current status of FDG–PET in tumour volume definition in radiotherapy treatment planning". Cancer Treatment Reviews. 32 (4): 245–260. doi:10.1016/j.ctrv.2006.02.002. ISSN 0305-7372.

[PurandareKulkarni2013-3] Purandare, Nilendu C.; Kulkarni, Aniruddha V.; Kulkarni, Suyash S.; Roy, Diptiman; Agrawal, Archi; Shah, Sneha; Rangarajan, Venkatesh (2013). "18F-FDG PET/CT-directed biopsy". Nuclear Medicine Communications. 34 (3): 203–210. doi:10.1097/MNM.0b013e32835c5a57. ISSN 0143-3636.

[PurandareRangarajan20152-4] Purandare, NilenduC; Rangarajan, Venkatesh (2015). "Imaging of lung cancer: Implications on staging and management". Indian Journal of Radiology and Imaging. 25 (2): 109. doi:10.4103/0971-3026.155831. ISSN 0971-3026.

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[4]

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 |[[Image:IJRI-25-109-g009.jpg|thumb|300px|FDG PET in nodal disease false-positive study. Maximum intensity projection (MIP) image shows an FDG-avid primary lung tumor on the right side (arrow, A) and multiple foci of FDG uptake in the mediastinum (arrowhead, A). CT scan shows enhancing, primary tumor (arrow, B). Fused PET/CT image shows FDG concentration in the mediastinal nodes, suggesting metastatic involvement. Mediastinoscopy and biospy revealed tuberculosis,via <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F9/>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.<ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>]]
-|Adrenal adenoma versus metastasis. Enhancing solid adrenal nodule on CT scan in a case of lung cancer (arrow, A) suggestive of metastatic deposit. Unenhanced CT scan shows fatty attenuation within the nodule with an HU value of 0 suggesting the possibility of an adenoma (arrow, B). FDG PET/CT shows no tracer concentration in the nodule, confirming the diagnosis of adenoma. Enhancing solid adrenal nodule on CT scan in another patient of lung cancer (arrow, D), which is indeterminate in nature. FDG PET/CT shows abnormal focal tracer concentration in the nodule (arrow, E) highly suggestive of a metastatic deposit via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F11/>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.☃☃
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