1
|
Mohammad S, Wijayaratne T, Mavilakandy A, Karim N, Theaker M, Reddy R, Tsaknis G. Is there a role for fibreoptic bronchoscopy in patients presenting with haemoptysis and negative CT? A systematic review and meta-analysis. BMJ Open Respir Res 2024; 11:e001972. [PMID: 38350978 PMCID: PMC10868274 DOI: 10.1136/bmjresp-2023-001972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/12/2023] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Haemoptysis can be a feature of lung cancer and patients are typically fast-tracked for evaluation with chest radiography, contrast-enhanced CT and fibreoptic bronchoscopy (FOB). OBJECTIVE We aim to explore whether FOB should be conducted as a component of the routine evaluation of non-massive haemoptysis, especially in the context of suspected lung cancer. METHODS MEDLINE, EMBASE and Cochrane Library were searched for studies comparing FOB with CT in the evaluation of non-massive haemoptysis while reporting at least one of the listed primary outcomes. Primary outcomes include sensitivity of diagnostic modality with respect to lung cancer. Secondary outcomes include detection of other aetiologies such as infection. Results were synthesised using a random effects meta-analysis. Sensitivity analysis was performed for patient age group and year of study. Risk of bias assessment was carried out with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. RESULTS A total of 2273 citations were screened and 11 studies were included, comprising a total sample size of 2015 patients with 226 confirmed cases of lung cancer. A total of 1816 and 1734 patients received a CT scan and FOB, respectively. The pooled sensitivities for detection of lung cancer using CT scan and bronchoscopy were 98% (95% CI 93.0% to 99.0%) and 86% (95% CI 63.0% to 95.0%), respectively. The sensitivity of CT was higher than that of FOB for both primary and secondary outcomes. CONCLUSION This study suggests that bronchoscopy does not offer significant additional diagnostic benefit in the evaluation of patients presenting with non-massive haemoptysis and a negative CT scan.
Collapse
Affiliation(s)
- Syed Mohammad
- Department of Respiratory Medicine, Lung Cancer Service, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Thisarana Wijayaratne
- Department of Respiratory Medicine, Lung Cancer Service, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Akash Mavilakandy
- Department of Respiratory Medicine, Lung Cancer Service, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Nawazish Karim
- Department of Respiratory Medicine, Lung Cancer Service, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Margaret Theaker
- Knowledge & Library Service, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Raja Reddy
- Department of Respiratory Medicine, Lung Cancer Service, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - George Tsaknis
- Department of Respiratory Medicine, Lung Cancer Service, Kettering General Hospital NHS Foundation Trust, Kettering, UK
- Department of Respiratory Sciences, University of Leicester, College of Life Sciences, Leicester, UK
| |
Collapse
|
2
|
Mohapatra MM, Rajaram M, Gochhait D, Kumar SV, Chakkalakkoombil SV. Can combined non-invasive methods improve diagnosis of lung cancer? J Cancer Res Ther 2023; 19:1142-1147. [PMID: 37787276 DOI: 10.4103/jcrt.jcrt_906_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Background Lung cancer is the most common malignancy in both gender. Early diagnosis is needed to reduce morbidity and mortality. There is a debate about the most accurate investigating modality for the diagnosis of lung cancer. Methods It is a retrospective cohort analysis to determine whether an approach of combined contrast-enhanced computed tomography (CECT) thorax with bronchoscopy method has higher sensitivity and specificity than combined CECT thorax with sputum cytology method. Records of patients with lung cancer who had visited the hospital within the last 6 months were retrospectively analyzed for their diagnostic modality. SPSS version 19 software was used for statistical analysis of the data. CECT scan thorax, bronchoscopy, and sputum cytology for lung cancer patients were analyzed. The CECT thorax plus bronchoscopy method was compared with the CECT thorax plus sputum cytology method. Their sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in diagnosing lung cancer were analyzed. Results Sixty-two patients were considered, including 62.9% males with a mean age of 55.5 years. In patients diagnosed with lung cancer, CECT thorax combined with bronchoscopy method was found to have a sensitivity of 96.67% than CECT thorax combined with sputum cytology method with a sensitivity of 90% and the difference in sensitivity between all individual approaches as well as the combined method was statistically significant with a P = 0.00001 and Chi-square value of 86.5909 owing to the low sensitivity of sputum cytology. CECT thorax combined with sputum cytology approach had a better specificity than CECT thorax combined with bronchoscopy. Conclusion Combined CECT thorax with sputum cytology method has a better specificity in diagnosing lung cancer than combined CECT thorax with bronchoscopy method.
Collapse
Affiliation(s)
| | - Manju Rajaram
- Department of Pulmonary Medicine, JIPMER, Puducherry, India
| | | | | | | |
Collapse
|
3
|
Afriyie-Mensah JS, Kwarteng E, Tetteh J, Sereboe L, Forson A. Flexible bronchoscopy in a tertiary healthcare facility: a review of indications and outcomes. Ghana Med J 2021; 55:18-25. [PMID: 38322384 PMCID: PMC10665266 DOI: 10.4314/gmj.v55i1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Objectives Flexible Fibreoptic bronchoscopy (FFB) is a major diagnostic and therapeutic tool employed largely in respiratory medicine but its use in our country has been quite limited. We performed a retrospective review of the indications, overall diagnostic yield and safety of FFB at the Korle-Bu Teaching Hospital (KBTH). Study Design Retrospective study. Study Setting Cardiothoracic Unit, Korle-Bu Teaching Hospital. Study Participants All bronchoscopy records from January 2017 - December 2018. Interventions Eight-five bronchoscopy reports generated over a 2-year period were reviewed. Using a data extraction form, patient's demographic details, indications for FFB, sedation given, specimen obtained and results of investigation, and complications encountered were recorded and entered into SPSS version 22. Descriptive analysis was performed and presented as means and percentages. Results Suspected lung cancer was the predominant indication for bronchoscopy requests (55.3%). Diagnostic yield of endobronchial biopsy was 86.7% increased to 93.3% when biopsy was combined with bronchial washing cytology. Bronchial washing geneXpert was positive in 20.8% of sputum negative cases, and 20.7% of patients with unresolved pneumonia and bronchiectasis had a positive microbial yield. Overall mild complications occurred in 5.9% of patients with no mortality. Conclusion Flexible bronchoscopy has a significantly high diagnostic yield, particularly in evaluating lung cancers and undiagnosed lung infections with minimal associated complications, hence increasing its availability in the country and widening the diagnostic scope at the cardiothoracic unit of the Korle-Bu Teaching Hospital. Funding None declared.
Collapse
Affiliation(s)
- Jane S Afriyie-Mensah
- Department of Medicine and Therapeutics, University of Ghana Medical School, Legon, Accra, Ghana
| | - Ernest Kwarteng
- Research Department of the University of Ghana Medical School, Accra, Ghana
| | - John Tetteh
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Lawrence Sereboe
- National Cardiothoracic Centre, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
| | - Audrey Forson
- Department of Medicine and Therapeutics, University of Ghana Medical School, Legon, Accra, Ghana
| |
Collapse
|
4
|
Zhou Q, Dong J, He J, Liu D, Tian DH, Gao S, Li S, Liu L, He J, Huang Y, Xu S, Mao W, Tan Q, Chen C, Li X, Zhang Z, Jiang G, Xu L, Zhang L, Fu J, Li H, Wang Q, Tan L, Li D, Zhou Q, Fu X, Jiang Z, Chen H, Fang W, Zhang X, Li Y, Tong T, Yu Z, Liu Y, Zhi X, Yan T, Zhang X, Casal RF, Pompeo E, Carretta A, Riquet M, Rena O, Falcoz PE, Saji H, Khan AZ, Danguilan JL, Gonzalez-Rivas D, Guibert N, Zhu C, Shen J. The Society for Translational Medicine: indications and methods of percutaneous transthoracic needle biopsy for diagnosis of lung cancer. J Thorac Dis 2018; 10:5538-5544. [PMID: 30416804 DOI: 10.21037/jtd.2018.09.28] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jingsi Dong
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jie He
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center, Beijing 100021, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - David H Tian
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Shugeng Gao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center, Beijing 100021, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine, Beijing 100006, China
| | - Lunxu Liu
- Department of Cardiovascular and Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Yunchao Huang
- Department of Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Kunming Medical University (Yunnan Tumor Hospital), Kunming 650100, China
| | - Shidong Xu
- Department of Thoracic surgery, Harbin Medical University Cancer Hospital, Harbin 150086, China
| | - Weimin Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Qunyou Tan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Zhu Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital of Tongji University, Shanghai 200433, China
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing 210009, China
| | - Lanjun Zhang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jianhua Fu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Beijing 100043, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Lijie Tan
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Danqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine, Beijing 100006, China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhongmin Jiang
- Department of Thoracic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University, Shanghai 200000, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University, Shanghai 200000, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300051, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou 450000, China
| | - Ti Tong
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun 130041, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shenyang 110042, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Tiansheng Yan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100083, China
| | - Xingyi Zhang
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun 130041, China
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Angelo Carretta
- Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Marc Riquet
- Georges Pompidou European Hospital, General Thoracic Surgery Department, Georges Pompidou European Hospital, Paris, France
| | - Ottavio Rena
- Thoracic Surgery Unit, University of Eastern Piedmont, AOU Maggiore della Carità, Vercelli, Italy
| | - Pierre-Emmanuel Falcoz
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ali Zamir Khan
- Department of Minimally Invasive Thoracic Surgery, Medanta The Medicity, Gurgaon, India
| | - Jose Luis Danguilan
- Lung Center of the Philippines, Quezon City, Philippines, USA.,University of the Philippines College of Medicine, Manila, Philippines, USA
| | | | - Nicolas Guibert
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Chengchu Zhu
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| | - Jianfei Shen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| |
Collapse
|
5
|
Anzidei M, Porfiri A, Andrani F, Di Martino M, Saba L, Catalano C, Bezzi M. Imaging-guided chest biopsies: techniques and clinical results. Insights Imaging 2017. [PMID: 28639114 PMCID: PMC5519500 DOI: 10.1007/s13244-017-0561-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background This article aims to comprehensively describe indications, contraindications, technical aspects, diagnostic accuracy and complications of percutaneous lung biopsy. Methods Imaging-guided biopsy currently represents one of the predominant methods for obtaining tissue specimens in patients with lung nodules; in many cases treatment protocols are based on histological information; thus, biopsy is frequently performed, when technically feasible, or in case other techniques (such as bronchoscopy with lavage) are inconclusive. Results Although a coaxial system is suitable in any case, two categories of needles can be used: fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB), with the latter demonstrated to have a slightly higher overall sensitivity, specificity and accuracy. Conclusion Percutaneous lung biopsy is a safe procedure even though a few complications are possible: pneumothorax, pulmonary haemorrhage and haemoptysis are common complications, while air embolism and seeding are rare, but potentially fatal complications. Teaching points • Imaging-guided biopsy is one of the main methods to obtain lung nodule specimens. • CT has the highest accuracy for diagnosis as an imaging guide. • Compared to FNAB, CNB has a higher accuracy for diagnosis. • Pneumothorax and parenchymal pulmonary haemorrhage care the most frequent complications. • Several clinical and technical variables can affect diagnostic accuracy and patient safety.
Collapse
Affiliation(s)
- Michele Anzidei
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy.
| | - Andrea Porfiri
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Fabrizio Andrani
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Michele Di Martino
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari, Polo di Monserrato, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Mario Bezzi
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
| |
Collapse
|
6
|
Koyi H, Johansson L, From J, Nyrén S. Biopsy testing in an inoperable, non-small cell lung cancer population-a retrospective, real-life study in Sweden. J Thorac Dis 2016; 7:2226-33. [PMID: 26793344 DOI: 10.3978/j.issn.2072-1439.2015.12.52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Correct diagnosis and staging are required for optimal treatment choice in lung cancer patients. This retrospective, patient medical records study investigated the clinical practice of lung cancer biopsy procedures and testing in Sweden. METHODS Consecutive patients with a recorded inoperable, malignant tumour of bronchus and lung were retrospectively identified at geographically widespread pulmonology clinics (NCT01139619). Data, including diagnostic sampling methodology [bronchoscopy, biopsy by pulmonologist and computed tomography (CT)-guided biopsy], were collected for patients diagnosed between 1 June 2009-31 May 2010, and analysed using descriptive statistics. A study-predefined algorithm, including six criteria on tumour localization and size, forced expiratory volume in one second (FEV1), blood saturation and risk of bleeding theoretically categorizing patient suitability for CT-guided biopsy, was used. RESULTS In total, 132 patients (mean age 68 years, 48% women, 61% adenocarcinoma, 86% current/ former smokers, 96% performance status ≤2, mean FEV1 volume ≥2 L) were included. The majority were examined by >1 diagnostic procedure (29% by CT-guided biopsy). Median overall time from first hospital contact to established diagnosis was 12.0 days (10.0 and 28.0 days for bronchoscopy and CT-guided biopsy, respectively). No major differences in lung function, age, performance status or predefined algorithm criteria were noted for patients examined by CT-guided biopsy versus bronchoscopy or biopsy. Complications were reported for 11 patients, including pneumothorax in six patients. Histopathology was used most frequently to diagnose and subtype (70%), although 66% of patients examined solely by bronchoscopy were diagnosed by cytology. For 26.5% of patients, epidermal growth factor receptor (EGFR) mutation testing was recorded. CONCLUSIONS No limitations regarding patient suitability or methodological complications were noted in this real-life, observational study. The CT-guided biopsy is a relatively safe and well-established method, and may need to be utilized further to fulfil current and future demands for faster diagnosis and high quality tissue as new tumour markers and targeted therapies become available.
Collapse
Affiliation(s)
- Hirsh Koyi
- 1 Department of Respiratory Medicine, Gävle Hospital; Centre for Research and Development Uppsala University, County Council of Gävleborg; and Karolinska Institutet, Stockholm, Sweden ; 2 Department of Pathology, Skåne University Hospital, Lund, Sweden ; 3 AstraZeneca NordicBaltic, Södertälje, Sweden ; 4 Department of Radiology, Solna, Karolinska University Hospital; and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Leif Johansson
- 1 Department of Respiratory Medicine, Gävle Hospital; Centre for Research and Development Uppsala University, County Council of Gävleborg; and Karolinska Institutet, Stockholm, Sweden ; 2 Department of Pathology, Skåne University Hospital, Lund, Sweden ; 3 AstraZeneca NordicBaltic, Södertälje, Sweden ; 4 Department of Radiology, Solna, Karolinska University Hospital; and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jesper From
- 1 Department of Respiratory Medicine, Gävle Hospital; Centre for Research and Development Uppsala University, County Council of Gävleborg; and Karolinska Institutet, Stockholm, Sweden ; 2 Department of Pathology, Skåne University Hospital, Lund, Sweden ; 3 AstraZeneca NordicBaltic, Södertälje, Sweden ; 4 Department of Radiology, Solna, Karolinska University Hospital; and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Sven Nyrén
- 1 Department of Respiratory Medicine, Gävle Hospital; Centre for Research and Development Uppsala University, County Council of Gävleborg; and Karolinska Institutet, Stockholm, Sweden ; 2 Department of Pathology, Skåne University Hospital, Lund, Sweden ; 3 AstraZeneca NordicBaltic, Södertälje, Sweden ; 4 Department of Radiology, Solna, Karolinska University Hospital; and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
7
|
Abstract
Inflexible and flexible bronchoscopy represents a standard diagnostic procedure in pneumology. Besides lung carcinomas, which is the most frequent indication for diagnostic bronchoscopy, a plethora of clinical symptoms such as chronic persistent cough, hoarseness, unexplained dyspnea, hemoptysis, and suspicious findings on auscultation require further endoscopic evaluation. Moreover, bronchoscopy plays a central role in the diagnostic work-up of interstitial lung diseases and persistent lung infiltrates, in particular those of infectious origin (e.g., fungal, viral, tuberculous, and Pneumocystis jiroveci infections). In addition, diagnostic bronchoscopy has more recently been complemented by endobronchial ultrasound (EBUS). EBUS is predominantly employed for the accurate diagnosis and mediastinal staging of lung carcinomas, and the assessment of lympadenopathy-associated diseases such as sarcoidosis.Since endoscopic evaluation is typically preceded by computed tomography (CT) of the chest, genuine incidental findings occur relatively seldom and usually account for pathological findings that have been missed on conventional imaging approaches. For instance, characteristic incidental findings include benign and malignant tumors in the area of the endoscopic access and central airways, anatomical variations and (vascular) malformations, tracheal and bronchial airway alterations, and aspirated objects. This review focuses on bronchoscopic findings that have either been completely missed by conventional imaging or differently interpreted due to its radiologic morphology.
Collapse
Affiliation(s)
- A Holland
- Klinik für Innere Medizin, Schwerpunkt Pneumologie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland,
| | | |
Collapse
|
8
|
Ofiara LM, Navasakulpong A, Beaudoin S, Gonzalez AV. Optimizing tissue sampling for the diagnosis, subtyping, and molecular analysis of lung cancer. Front Oncol 2014; 4:253. [PMID: 25295226 PMCID: PMC4170137 DOI: 10.3389/fonc.2014.00253] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/03/2014] [Indexed: 01/15/2023] Open
Abstract
Lung cancer has entered the era of personalized therapy with histologic subclassification and the presence of molecular biomarkers becoming increasingly important in therapeutic algorithms. At the same time, biopsy specimens are becoming increasingly smaller as diagnostic algorithms seek to establish diagnosis and stage with the least invasive techniques. Here, we review techniques used in the diagnosis of lung cancer including bronchoscopy, ultrasound-guided bronchoscopy, transthoracic needle biopsy, and thoracoscopy. In addition to discussing indications and complications, we focus our discussion on diagnostic yields and the feasibility of testing for molecular biomarkers such as epidermal growth factor receptor and anaplastic lymphoma kinase, emphasizing the importance of a sufficient tumor biopsy.
Collapse
Affiliation(s)
- Linda Marie Ofiara
- Respiratory Medicine Division, Department of Medicine, McGill University Health Centre, Montreal Chest Institute , Montreal, QC , Canada
| | - Asma Navasakulpong
- Respiratory Medicine Division, Department of Medicine, McGill University Health Centre, Montreal Chest Institute , Montreal, QC , Canada ; Pulmonary and Respiratory Critical Care Division, Faculty of Medicine, Prince of Songkla University , Hatyai , Thailand
| | - Stephane Beaudoin
- Respiratory Medicine Division, Department of Medicine, McGill University Health Centre, Montreal Chest Institute , Montreal, QC , Canada
| | - Anne Valerie Gonzalez
- Respiratory Medicine Division, Department of Medicine, McGill University Health Centre, Montreal Chest Institute , Montreal, QC , Canada
| |
Collapse
|
9
|
The use of bronchial arteries in the characterization of primary lung cancer: an MDCT study. J Comput Assist Tomogr 2014; 38:169-73. [PMID: 24448502 DOI: 10.1097/rct.0b013e3182aa6753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to discuss the use of ipsilateral bronchial artery dilatation when a solitary lung mass is detected on multidetector computed tomography (MDCT). MATERIALS AND METHODS We retrospectively evaluated 55 patients with solitary lung mass. An MDCT scanner was used for the study. Location and the greatest size of the tumor, and ipsilateral bronchial artery caliper (dilated if >2 mm) were noted for each patient. TNM staging of each patient with primary lung cancer was also recorded. Statistical analyses were applied to both groups using SPSS 17.0. χ test was used for the statistical analyses. RESULTS Statistically strong correlation was observed between ipsilateral bronchial artery dilatation and primary lung carcinoma. Among the 11 benign lung masses, only 2 (18%) showed ipsilateral bronchial artery dilatation. But 39 (88.6%) of the 44 primary lung carcinoma patients and 36 (92.3%) of the 39 primary lung carcinoma patients with predominantly extramediastinal (lung) location showed ipsilateral bronchial artery dilatation on MDCT. When only predominantly extramediastinal lesions were taken into account, sensitivity of the study was 92.31%, specificity was 81.82%, positive predictive value was 94.74%, and negative predictive value was 75%. CONCLUSIONS Lesion characterization and accuracy was very high when the only criteria of bronchial artery dilatation are taken into account. Sensitivity and negative predictive value were higher in the patients with extramediastinal lesions.
Collapse
|
10
|
Ofiara LM, Navasakulpong A, Ezer N, Gonzalez AV. The importance of a satisfactory biopsy for the diagnosis of lung cancer in the era of personalized treatment. ACTA ACUST UNITED AC 2012; 19:S16-23. [PMID: 22787407 DOI: 10.3747/co.19.1062] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Advances in molecular biology are improving the understanding of lung cancer and changing the approach to treatment. A satisfactory biopsy that allows for histologic characterization and mutation analysis is becoming increasingly important. Most patients with lung cancer are diagnosed at an advanced stage, and diagnosis is often based on a small biopsy or cytology specimen. Here, we review the techniques available for making a diagnosis of lung cancer, including bronchoscopy, ultrasound-guided bronchoscopy, mediastinoscopy, transthoracic needle aspiration, thoracentesis, and medical thoracoscopy. We also discuss the indications, complications, and tissue yields of those techniques, especially as they pertain to testing for molecular markers.
Collapse
Affiliation(s)
- L M Ofiara
- Division of Respiratory Medicine, McGill University Health Centre, Montreal General Hospital, Montreal, QC
| | | | | | | |
Collapse
|
11
|
Muylle I, De Meulder I, Bruyneel M, Ninane V. [EBUS: a long and quiet river]. Rev Mal Respir 2012; 29:739-40. [PMID: 22742460 DOI: 10.1016/j.rmr.2011.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 05/31/2011] [Indexed: 10/16/2022]
|
12
|
Endobronchial ultrasound increases the diagnostic yields of polymerase chain reaction and smear for pulmonary tuberculosis. J Thorac Cardiovasc Surg 2010; 139:1554-60. [PMID: 20494195 DOI: 10.1016/j.jtcvs.2010.02.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 11/22/2009] [Accepted: 02/09/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Our objective was to determine the contribution of endobronchial ultrasound in the diagnostic yields of acid-fast bacillus smear, nucleic acid amplification tests, and culture in bronchoalveolar lavage fluid for pulmonary tuberculosis. METHODS During a 1-year interval, 99 patients who had initial sputum-negative acid-fast bacillus smears or no sputum but were later proven to have a positive culture for Mycobacterium tuberculosis in their sputum or bronchoalveolar lavage fluid were retrospectively studied. Among them, 56 patients underwent bronchoscopy with endobronchial ultrasound (EBUS group) and 43 patients received conventional bronchoscopy for bronchoalveolar lavage (non-EBUS group). RESULTS The diagnostic yields of the nucleic acid amplification tests (89.3%, 50/56; P = .006), acid-fast bacillus smear (30.4%, 17/56; P = .013), and M tuberculosis culture in bronchoalveolar lavage fluid (67.9%, 38/56; P = .041) were significantly higher in the EBUS group of patients. The results of those who underwent conventional bronchoscopy were 65.1% (28/43), 9.3% (4/43), and 46.5% (20/43), respectively. Combining bronchoalveolar lavage fluid smear and nucleic acid amplification tests, we made a rapid diagnosis of pulmonary tuberculosis in 51 (91.1%) of the 56 EBUS patients and 29 (67.4%; P = .004) of the 43 non-EBUS patients. CONCLUSIONS The introduction of endobronchial ultrasound increases the diagnostic yield of the nucleic acid amplification tests, acid-fast bacillus smear, and M tuberculosis culture from bronchioalveolar lavage fluid in patients with pulmonary tuberculosis who have negative sputum smear or no sputum production.
Collapse
|
13
|
|
14
|
[Diagnostic flexible bronchoscopy. Recommendations of the Endoscopy Working Group of the French Society of Pulmonary Medicine]. Rev Mal Respir 2008; 24:1363-92. [PMID: 18216755 DOI: 10.1016/s0761-8425(07)78513-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
These guidelines on flexible bronchoscopy depict important clues to be known and taken into account while practicing flexible bronchoscopy, in adult, except in emergency situations. This is a practical clarification. Safety conditions, complications, anesthesia, infectious risks, cleaning and disinfection are detailed from a review of the literature. Intensive care practice of bronchoscopy requires more attention due to higher risks patients and is discussed extensively. Standards and performances of the various sampling techniques complete this work. Indications for bronchoscopy, therapeutic and paediatric bronchoscopy are not covered in these guidelines.
Collapse
|
15
|
Whynes DK. Could CT screening for lung cancer ever be cost effective in the United Kingdom? COST EFFECTIVENESS AND RESOURCE ALLOCATION 2008; 6:5. [PMID: 18302756 PMCID: PMC2292150 DOI: 10.1186/1478-7547-6-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Accepted: 02/26/2008] [Indexed: 02/04/2023] Open
Abstract
Background The absence of trial evidence makes it impossible to determine whether or not mass screening for lung cancer would be cost effective and, indeed, whether a clinical trial to investigate the problem would be justified. Attempts have been made to resolve this issue by modelling, although the complex models developed to date have required more real-world data than are currently available. Being founded on unsubstantiated assumptions, they have produced estimates with wide confidence intervals and of uncertain relevance to the United Kingdom. Method I develop a simple, deterministic, model of a screening regimen potentially applicable to the UK. The model includes only a limited number of parameters, for the majority of which, values have already been established in non-trial settings. The component costs of screening are derived from government guidance and from published audits, whilst the values for test parameters are derived from clinical studies. The expected health gains as a result of screening are calculated by combining published survival data for screened and unscreened cohorts with data from Life Tables. When a degree of uncertainty over a parameter value exists, I use a conservative estimate, i.e. one likely to make screening appear less, rather than more, cost effective. Results The incremental cost effectiveness ratio of a single screen amongst a high-risk male population is calculated to be around £14,000 per quality-adjusted life year gained. The average cost of this screening regimen per person screened is around £200. It is possible that, when obtained experimentally in any future trial, parameter values will be found to differ from those previously obtained in non-trial settings. On the basis both of differing assumptions about evaluation conventions and of reasoned speculations as to how test parameters and costs might behave under screening, the model generates cost effectiveness ratios as high as around £20,000 and as low as around £7,000. Conclusion It is evident that eventually being able to identify a cost effective regimen of CT screening for lung cancer in the UK is by no means an unreasonable expectation.
Collapse
Affiliation(s)
- David K Whynes
- Professor of Health Economics, School of Economics, University of Nottingham, Nottingham, NG7 2RD, UK.
| |
Collapse
|
16
|
Ninane V, Roche N. [Good clinical practice of diagnostic flexible bronchoscopy: recommendations or guidelines?]. Rev Mal Respir 2008; 24:1261-4. [PMID: 18216746 DOI: 10.1016/s0761-8425(07)78504-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
17
|
Turner MO, Mayo JR, Müller NL, Schulzer M, FitzGerald JM. The value of thoracic computed tomography scans in clinical diagnosis: a prospective study. Can Respir J 2007; 13:311-6. [PMID: 16983446 PMCID: PMC2683318 DOI: 10.1155/2006/859870] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Computed tomography (CT) scans are used extensively to investigate chest disease because of their cross-sectional perspective and superior contrast resolution compared with chest radiographs. These advantages lead to a more accurate imaging assessment of thoracic disease. The actual use and evaluation of the clinical impact of thoracic CT has not been assessed since scanners became widely available. OBJECTIVE To identify patterns of utilization, waiting times and the impact of CT scan results on clinical diagnoses. DESIGN A before and after survey of physicians who had ordered thoracic CT scans. SETTING Vancouver General Hospital--a tertiary care teaching centre in Vancouver, British Columbia. SUBJECTS Physicians who had ordered CT scans. INTERVENTION Physicians completed a standard questionnaire before and after the CT scan result was available. MEASUREMENTS Changes in the clinical diagnosis, estimates of the probabilities for the diagnosis both before and after the CT scan, and waiting times. RESULTS Four hundred fifty-four thoracic CT cases had completed questionnaires, of whom 80% were outpatients. A change in diagnosis was made in 48% of cases (25% with a normal CT scan and 23% with CT scan findings that indicated a different diagnosis). The largest change in probability scores for the clinical diagnosis before and after the CT scan was 43.9% for normal scans, while it was 36.3% for a different diagnosis and 26.3% for the same diagnosis. High-priority scans were associated with decreased waiting time (--7.89 days for each unit increase in priority). CONCLUSIONS The CT scan results were associated with a change in diagnosis in 48% of cases. Normal scans constituted 25% of the total and had the greatest impact scores. Waiting times were highly correlated with increased urgency of the presenting problem.
Collapse
Affiliation(s)
- Mark O Turner
- Respiratory Division, University of British Columbia and Vancouver General Hospital, Vancouver Coastal Research Institute, Vancouver, British Columbia
| | - John R Mayo
- Department of Radiology, University of British Columbia and Vancouver General Hospital, Vancouver Coastal Research Institute, Vancouver, British Columbia
- Correspondence: Dr John Mayo, Department of Radiology, Vancouver General Hospital, 899 West 12th Avenue, Vancouver, British Columbia V5Z 1M9. Telephone 604-875-4111 ext 63193, fax 604-875-5498, e-mail
| | - Nestor L Müller
- Department of Radiology, University of British Columbia and Vancouver General Hospital, Vancouver Coastal Research Institute, Vancouver, British Columbia
| | - Michael Schulzer
- Centre for Clinical Epidemiology and Evaluation, University of British Columbia and Vancouver General Hospital, Vancouver Coastal Research Institute, Vancouver, British Columbia
| | - J Mark FitzGerald
- Respiratory Division, University of British Columbia and Vancouver General Hospital, Vancouver Coastal Research Institute, Vancouver, British Columbia
- Centre for Clinical Epidemiology and Evaluation, University of British Columbia and Vancouver General Hospital, Vancouver Coastal Research Institute, Vancouver, British Columbia
| |
Collapse
|
18
|
Pfannenberg AC, Aschoff P, Brechtel K, Müller M, Bares R, Paulsen F, Scheiderbauer J, Friedel G, Claussen CD, Eschmann SM. Low dose non-enhanced CT versus standard dose contrast-enhanced CT in combined PET/CT protocols for staging and therapy planning in non-small cell lung cancer. Eur J Nucl Med Mol Imaging 2006; 34:36-44. [PMID: 16896664 DOI: 10.1007/s00259-006-0186-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Accepted: 04/03/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate low dose non-enhanced CT and standard dose contrast-enhanced CT in combined PET/CT protocols for staging and therapy planning of non-small cell lung cancer (NSCLC). METHODS Retrospective analysis was performed of 50 consecutive patients with proven NSCLC who had been referred for primary staging (n=41) or restaging (n=9). All patients underwent a multi-phase PET/CT consisting of a low dose non-enhanced attenuation scan and an arterial and portal-venous contrast-enhanced CT scan followed by whole-body PET. Fused datasets of non-enhanced and contrast-enhanced PET/CT were compared per patient by using the TNM staging system, and per lesion regarding localisation, characterisation and delineation of tumour lesions. The staging results were validated either by histopathology or by clinical-radiological follow-up for >or=6 months. RESULTS In 47/50 patients, the results of T staging did not differ between the two PET/CT protocols. Three patients could only be correctly classified as having T4 tumours after contrast application. Regarding N staging, both protocols yielded the same results. In M staging, there was only one patient with an improvement of the results as a result of contrast application. The lesion-based analysis of 92 sites showed no difference in the accuracy of lesion localisation and only one revision of lesion characterisation by contrast-enhanced PET/CT. The assessment of tumour delineation was altered by contrast application in 58/92 sites (p<0.0001). In 10/50 patients, contrast-enhanced PET/CT detected additional clinically important findings. CONCLUSION In patients with advanced NSCLC, contrast-enhanced CT as part of the PET/CT protocol more accurately assessed the TNM stage in 8% of patients compared with non-contrast PET/CT. However, for planning of 3D conformal radiotherapy and non-conventional surgery, contrast-enhanced PET/CT protocols are indispensable owing to their superiority in precisely defining the tumour extent.
Collapse
Affiliation(s)
- Anna C Pfannenberg
- Department of Diagnostic Radiology, Eberhard-Karls-University, Tübingen, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
|
20
|
Enhanced Virtual Bronchoscopy Using the Pulmonary Artery: Improvement in Route Mapping for Ultraselective Transbronchial Lung Biopsy. AJR Am J Roentgenol 2004; 183:1103-10. [PMID: 15385314 DOI: 10.2214/ajr.183.4.1831103] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
21
|
Carette MF, Khalil A, Parrot A. Hémoptysies : principales étiologies et conduite à tenir. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.emcpn.2004.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
22
|
Manhire A, Charig M, Clelland C, Gleeson F, Miller R, Moss H, Pointon K, Richardson C, Sawicka E. Guidelines for radiologically guided lung biopsy. Thorax 2003; 58:920-36. [PMID: 14586042 PMCID: PMC1746503 DOI: 10.1136/thorax.58.11.920] [Citation(s) in RCA: 289] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- A Manhire
- Department of Radiology, Nottingham City Hospital, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Khoo KL, Chua GSW, Mukhopadhyay A, Lim TK. Transbronchial needle aspiration: initial experience in routine diagnostic bronchoscopy. Respir Med 2003; 97:1200-4. [PMID: 14635974 DOI: 10.1016/s0954-6111(03)00230-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Transbronchial needle aspiration (TBNA) has been shown to be useful not only for the diagnosis and staging of lung cancer, its most widely studied indication, but also for many of other clinical indications. Despite this, it remains largely underutilized, mainly because of concerns with poor yield, safety, lack of experience of the bronchoscopist, and lack of cytopathological support. OBJECTIVE To study the clinical utility and yield of TBNA as an adjunct to other conventional procedures in diagnostic bronchoscopy at a centre that was relatively inexperienced with this technique, but where there was availability of rapid on-site evaluation (ROSE). Most of the major indications for TBNA in both malignant as well as benign disease were included. SETTING University Teaching Hospital naïve to the procedure. PATIENT AND METHODS Forty-five consecutive patients who underwent TBNA as part of diagnostic bronchoscopy during a 2-year study period. RESULTS TBNA gave a yield of 65% for evaluation of mediastinal disease, both benign and malignant. The overall diagnostic utility for all indications was 71% and there were no complications. CONCLUSIONS We conclude that TBNA is a useful and safe adjunct to diagnostic bronchoscopy in routine clinical practice. It has a satisfactory yield even with an inexperienced team, if used with ROSE.
Collapse
Affiliation(s)
- Kay-Leong Khoo
- Division of Respiratory Medicine, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
| | | | | | | |
Collapse
|
24
|
Traill ZC, Gleeson FV. Bronchoscopy and surgical staging procedures and their correlation with imaging. Eur J Radiol 2003; 45:39-48. [PMID: 12499063 DOI: 10.1016/s0720-048x(02)00298-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Bronchoscopy, computed tomography (CT) and surgical staging procedures are complimentary methods of investigating patients with lung cancer. CT has been shown to be of value prior to bronchoscopy in the investigation of haemoptysis and malignancy, with excellent correlation between the detection of disease within the large airways on CT and direct visualisation at bronchoscopy. The utility of CT has been further increased by the development of multislice scanners with the generation of volumetric data enabling multiplanar image acquisition. Additionally the advent of CT co-registered with positron emission tomography will play an important role in guiding the choice of surgical staging procedures The increasing use of multidisciplinary medical care requires radiologists to have a greater understanding of the abilities and limitations of both bronchoscopy and surgical staging procedures in evaluating disease demonstrated on imaging.
Collapse
Affiliation(s)
- Z C Traill
- Radiology Department, Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ, UK
| | | |
Collapse
|
25
|
Spiro SG, Porter JC. Lung cancer--where are we today? Current advances in staging and nonsurgical treatment. Am J Respir Crit Care Med 2002; 166:1166-96. [PMID: 12403687 DOI: 10.1164/rccm.200202-070so] [Citation(s) in RCA: 169] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lung cancer remains the commonest cause of cancer death in both men and women in the developed world, although mortality rates for men are dropping. Spiral computed tomography (CT) of the chest in middle-aged, smoking subjects may identify two to four times more lung cancers than a chest X-ray, with more than 70% of tumors being Stage I. The incidence of benign nodules is high, making interpretation difficult. Randomized controlled trials are required to determine whether spiral CT detects lung cancer early enough to improve mortality. Preoperative staging has relied on CT scans, but positron emission tomography scanning has greater sensitivity, specificity, and accuracy than CT and is recommended as the final confirmatory investigation when the CT shows resectable disease. In locally advanced non-small cell lung cancer, there is a small advantage for the addition of chemotherapy to radiotherapy, but no advantage for postoperative radiotherapy. Chemotherapy gives no benefit when given as neoadjuvant or adjuvant treatment around surgery. In advanced disease, newer cytotoxic agents confer a small survival advantage over older combinations, but the advantage in median survival over best supportive care remains a few months with modest improvements in quality of life. Survival with small cell lung cancer has shown little increase over the last 15 years despite multiple attempts to manipulate the timing, dose intensity of chemotherapy, and the potential of radiotherapy. Novel therapies are urgently needed for all cell types of lung cancer.
Collapse
Affiliation(s)
- Stephen G Spiro
- Department of Respiratory Medicine, University College, London Hospitals National Health Service Trust, United Kingdom.
| | | |
Collapse
|
26
|
Loubeyre P. [Imaging of lung cancer: role of radiology]. Cancer Radiother 2001; 5:671-84. [PMID: 11715318 DOI: 10.1016/s1278-3218(01)00123-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The aim of this review is to discuss the imaging available for diagnostic, therapy and follow-up for lung cancer management.
Collapse
Affiliation(s)
- P Loubeyre
- Centre hospitalier Lyon-Sud, 69310 Pierre-Bénite, France
| |
Collapse
|
27
|
Padley SP. Thoracic radiology. Clin Radiol 2001; 56:191-2. [PMID: 11247694 DOI: 10.1053/crad.2000.0622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S P Padley
- Chelsea and Westminster Hospital, 369 Fulham Palace Road, London, SW10 9NH, UK.
| |
Collapse
|