Squamous cell carcinoma of the lung other diagnostic studies

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 squamous cell carcinoma of the lung, include: thoracotomy, thoracoscopy, bronchoscopy, mediastinoscopy, transthoracic percutaneous fine needle aspiration, and sputum cytology.

Other Diagnostic Studies

Other diagnostic modalities for squamous cell carcinoma of the lung include:^[1]

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 or sputum cytology varies by location of the lung cancer

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.^[2]^[3]^[4]^[5]^[6]^[7]^[8]


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
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 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 Wang needle	Less invasive than above methods	Relatively low yield Not widely practiced Bleeding risk

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.
↑ 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.
↑ Kim ES, Bosquée L (June 2007). “The importance of accurate lymph node staging in early and locally advanced non-small cell lung cancer: an update on available techniques”. J Thorac Oncol. 2 Suppl 2: S59–67. doi:10.1097/01.JTO.0000269738.13586.fd. PMID 17589301.
↑ Wiersema M et al. Real-time endoscopic ultrasound-guided fine-needle aspiration of a mediastinal lymph node. Gastrointest Endosc 1993, 39(3):429-431
↑ Wallace MB, Pascual JM, Raimondo M, et al. (February 2008). “Minimally invasive endoscopic staging of suspected lung cancer”. JAMA. 299 (5): 540–6. doi:10.1001/jama.299.5.540. PMID 18252884.
↑ Singh P et al. Endoscopic ultrasound as a first test for diagnosis and staging of lung cancer: a prospective study. Am J Respir Crit Care Med 2007, 175(4):345-354.
↑ Cerfolio R, Bryant A, Ojha B: Restaging patients with N2 (stage IIIa) non-small cell lung cancer after neoadjuvant chemoradiotherapy: a prospective study. J Thorac Cardiovasc Surg 2006, 131(6):1229-1235
↑ Yasufuku K et al. Endobronchial ultrasonography: current status and future directions. J Thorac Oncol 2007, 2(10):970-979.

Template:WikiDoc Sources

[pmid24484269-1] 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.

[pmid17296659-2] 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.

[pmid17589301-3] Kim ES, Bosquée L (June 2007). “The importance of accurate lymph node staging in early and locally advanced non-small cell lung cancer: an update on available techniques”. J Thorac Oncol. 2 Suppl 2: S59–67. doi:10.1097/01.JTO.0000269738.13586.fd. PMID 17589301.

[Wiersema-4] Wiersema M et al. Real-time endoscopic ultrasound-guided fine-needle aspiration of a mediastinal lymph node. Gastrointest Endosc 1993, 39(3):429-431

[pmid18252884-5] Wallace MB, Pascual JM, Raimondo M, et al. (February 2008). “Minimally invasive endoscopic staging of suspected lung cancer”. JAMA. 299 (5): 540–6. doi:10.1001/jama.299.5.540. PMID 18252884.

[Singh-6] Singh P et al. Endoscopic ultrasound as a first test for diagnosis and staging of lung cancer: a prospective study. Am J Respir Crit Care Med 2007, 175(4):345-354.

[Cerfolio-7] Cerfolio R, Bryant A, Ojha B: Restaging patients with N2 (stage IIIa) non-small cell lung cancer after neoadjuvant chemoradiotherapy: a prospective study. J Thorac Cardiovasc Surg 2006, 131(6):1229-1235

[Yasufuku-8] Yasufuku K et al. Endobronchial ultrasonography: current status and future directions. J Thorac Oncol 2007, 2(10):970-979.

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