Non small cell lung cancer other diagnostic studies: Difference between revisions
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Lung adenocarcinoma]] | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Lung adenocarcinoma]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Nuclear atypia | *Nuclear [[atypia]] | ||
*Eccentrically placed nuclei | *Eccentrically placed nuclei | ||
*Abundant cytoplasm - classically with mucin vacuoles | *Abundant cytoplasm - classically with [[Mucin|mucin vacuoles]] | ||
*Often conspicuous [[nucleoli]] | *Often conspicuous [[nucleoli]] | ||
*[[Nuclear pseudoinclusions]] | *[[Nuclear pseudoinclusions]] | ||
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| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Central nucleus | *Central nucleus | ||
*Dense appearing cytoplasm, usually eosinophilic | *Dense appearing cytoplasm, usually [[eosinophilic]] | ||
*Small nucleolus | *Small nucleolus | ||
*Intracellular bridges - classic | *Intracellular bridges - classic | ||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Large cell carcinoma of the lung|Large cell lung carcinoma]] | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Large cell carcinoma of the lung|Large cell lung carcinoma]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Large polygonal cells and anaplastic cells | *Large polygonal cells and [[Anaplasia|anaplastic cells]] | ||
*Solid nests without obvious squamous or glandular differentiation | *Solid nests without obvious [[Squamous cell|squamous]] or [[Glandular|glandular differentiation]] | ||
*Moderately abundant cytoplasm | *Moderately abundant cytoplasm | ||
*Well defined cell borders | *Well defined cell borders | ||
Revision as of 15:43, 16 January 2019
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Non Small Cell Lung Cancer Microchapters |
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Differentiating Non Small Cell Lung Cancer from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2],Maria Fernanda Villarreal, M.D. [3]
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: Bronchoscopy is used to obtain a specimen for histopathological subtyping and immunohistochemical staining by the following methods:
- 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 |
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| Left parasternal mediastinotomy |
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| Chamberlain procedure |
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| Cervical mediastinoscopy |
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| Video-assisted thoracoscopy |
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| Transthoracic percutaneous fine needle aspiration under CT guidance |
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| Bronchoscopy with blind transbronchial Wang needle |
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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 |
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| Squamous cell lung carcinoma |
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| Large cell lung carcinoma |
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| Adenosquamous carcinoma |
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| Sarcomatoid carcinoma |
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| Carcinoid tumor |
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| Salivary gland tumor |
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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.