Pancoast tumor other diagnostic studies

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

Overveiw

Other diagnostic studies for evaluating the spread of pancoast tumor include bone scintigraphy, PET scan, and molecular tests.

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 and treatment options 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/>[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/>[1]
Incremental value of FDG PET/CT in baseline staging. MIP image of FDG PET scan shows intense tracer concentration in the right hemithorax (arrow, A) corresponding to a right lung mass (arrow, B). Also seen are two FDG-avid foci in the abdomen (arrowheads, A) which correspond to peritoneal metastatic deposits (arrowhead, C). Note that the peritoneal deposit is almost indistinguishable from adjacent bowel (arrowhead, D). Due to PET/CT findings, the intent of treatment changes from curative surgery of a resectable mass to palliative chemotherapy, via<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419420/figure/F15/>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. ↑ 1.0 1.1 1.2 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.
  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.
  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.
  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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