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, mediastinoscopy, and transthoracic percutaneous fine needle aspiration.
Other Diagnostic Studies
- There are numerous diagnostic modalities which 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 (surgical opening of the chest) | 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 |
| Extended cervical mediastinoscopy combined with a Chamberlain procedure, which is also called a 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 |