Initial evaluation of the nonsmall cell lung cancer patient: diagnosis and staging. Curr Opin Pulm Med

Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
Current opinion in pulmonary medicine (Impact Factor: 2.76). 07/2010; 16(4):307-14. DOI: 10.1097/MCP.0b013e32833ab0b6
Source: PubMed


The initial diagnosis and staging of nonsmall cell lung cancer patients is complex and involves multiple technologies. This review evaluates the recent literature and integrates it into a systematic method for evaluating patients.
The goal of the initial diagnosis and staging of nonsmall cell lung cancer is to provide sufficient information to allow definitive treatment. Initial steps should include a history and physical, basic laboratory tests, pulmonary functions, and PET-computed tomography (CT) imaging. If there is evidence of metastatic disease, then biopsy of the most advanced lesion is warranted. If there is no evidence of metastatic disease, the evaluation should focus on evaluation of the mediastinal lymph nodes. If there is evidence of nodal involvement by PET-CT, then endobronchial ultrasound-guided transbronchial needle aspiration is warranted. If there is no evidence of nodal involvement on PET-CT, then either surgery or CT-guided fine needle aspiration is warranted. Other factors that should be kept in mind when selecting a diagnostic strategy include whether or not the patient is a surgical candidate, the impact of comorbidities, the type of cancer, the need for predictive biomarker analysis, and the range of possible treatment options.
Integrating new technologies such as PET-CT and endobronchial ultrasound into the initial evaluation of patients can save unnecessary diagnostic procedures and lead to more rapid and accurate staging.

3 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The approach to the SPN involves a careful evaluation of the patient, beginning with a history and physical examination with particular attention to risk factors for malignancy. Old CXRs should be obtained and a CT scan is usually indicated if the nodule is not demonstrated to be stable for 2 yr or more. Additional imaging with CT with contrast infusion or PET, or both, may help to further define the nodule. An estimate of the probability of malignancy is then made and a strategy of observation, biopsy, or thoracotomy is chosen on the basis of the probability of malignancy, as well as an individual assessment of the patient. Future developments need to improve case finding techniques, to assess the impact of newer technologies on decision analysis, and to integrate this with the effect of new multimodality treatments for lung cancer.
    American Journal of Respiratory and Critical Care Medicine 10/2000; 162(3 Pt 1):782-7. DOI:10.1164/ajrccm.162.3.9812152 · 13.00 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Endobronchial ultrasound (EBUS) and electromagnetic navigation bronchoscopy (ENB) have increased the diagnostic yield of bronchoscopic diagnosis of peripheral lung lesions. However, the role of combining these modalities to overcome each individual technique's limitations and, consequently, to further increase the diagnostic yield remains untested. Objectives: A prospective randomized controlled trial involving three diagnostic arms: EBUS only, ENB only, and a combined procedure. All procedures were performed via flexible bronchoscopy and transbronchial forceps biopsies were obtained without fluoroscopic guidance. In the combined group, after electromagnetic navigation, the ultrasound probe was passed through an extended working channel to visualize the lesion. Biopsies were taken if ultrasound visualization showed that the extended working channel was within the target. Primary outcome was diagnostic yield. The reference "gold standard" was a surgical biopsy if bronchoscopic biopsy did not reveal a definite histological diagnosis compatible with the clinical presentation. Secondary outcomes were yields by size, lobar distribution, and lesion pathology. Complication rates were also documented. Of the 120 patients recruited, 118 had a definitive histological diagnosis and were included in the final analysis. The diagnostic yield of the combined procedure (88%) was greater than EBUS (69%) or ENB alone (59%; p = 0.02). The combined procedure's yield was independent of lesion size or lobar distribution. The pneumothorax rates ranged from 5 to 8%, with no significant differences between the groups. Combined EBUS and ENB improves the diagnostic yield of flexible bronchoscopy in peripheral lung lesions without compromising safety.
    American Journal of Respiratory and Critical Care Medicine 08/2007; 176(1):36-41. DOI:10.1164/rccm.200612-1866OC · 13.00 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Behavioral heterogeneity within a given patient cohort has been a major challenge in clinical practice and is probably most prominently observed in the field of oncology. This has been the prime impetus of the cutting-edge preclinical and clinical research studies over recent times, many of which seek to further stratify patients based on patients' genetic, proteomic, and metabolic profile (the three key components of "-omics" research), in order to select the appropriate therapy according to an individual's best-fit. Data from functional radionuclide imaging particularly that obtained from PET-CT, with regard to characterization of an individual's tumor phenotype, can play a very important role in answering some of the critical decision-making questions on an individual basis. The role of molecular imaging with PET, SPECT, and planar radionuclide technologies is not confined to early response assessment of administered therapeutics (which is its major benefit compared to conventional methods), rather it has a much broader perspective and encompasses multiple steps in decision making steps of patient management. The immense impact of the radionuclide-based molecular imaging techniques on the selection of an appropriate treatment (at initial diagnosis, during therapy, or after therapy) or in defining the tumor biology has been documented and increasingly recognized through both large and small-scale studies. However, there has been relatively less systematic effort towards the development of a successful and definitive clinical model of "personalized cancer medicine" (based on accurate disease triaging on an individual basis) by the medical community that would be suitable for routine adoption. In this paper, an endeavor has been made to explore the potential of this approach and underscore the areas that would require further critical evaluation to make this a reality.
    Discovery medicine 01/2012; 13(68):65-73. · 3.63 Impact Factor
Show more

Similar Publications