Semin Respir Crit Care Med 2000; Volume 21(Number 05): 393-404
DOI: 10.1055/s-2000-9401
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Case Studies in the Diagnosis and Staging of Non-Small Cell Lung Cancer

Christopher E. Avendano, Gerard A. Silvestri
  • Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, South Carolina
Further Information

Publication History

Publication Date:
31 December 2000 (online)

ABSTRACT

Lung cancer is the most common cause of cancer death in men and women. While overall survival rates remain dismal, survival for early stage disease approaches 70%. Expedient, accurate staging is vital to ensure timely resection of all potentially curable disease. Conversely, accurate staging is important in preventing unnecessary surgery. While a negative clinical evaluation has a high negative predictive value, many clinicians routinely order conventional imaging to exclude distant metastases. In this article, five case vignettes are presented to demonstrate the international system for staging lung cancer, including the most recent modifications. Various tumor characteristics and patterns of lymph node involvement are explored to demonstrate the subtleties of staging. The accuracy of various diagnostic modalities in the evaluation for mediastinal and distant metastasis is discussed.

REFERENCES

  • 1 Greenlee R T, Murray T, Bolden S. Cancer statistics, 2000.  CA . 2000;  50 7-33
  • 2 Billing J, Wells F. Delays in the diagnosis and surgical treatment of lung cancer.  Thorax . 1996;  51 903-906
  • 3 Lillington G. Management of the solitary pulmonary nodule.  Hosp Prac . 1993;  28 41-48
  • 4 Westcott J. Percutaneous transthoracic needle biopsy.  Radiology . 1988;  169 593-601
  • 5 Zernouni E, Stitik F, Siegelman S. CT of the pulmonary nodule: A cooperative study.  Radiology . 1986;  160 319-327
  • 6 ATS/ERS. Pretreatment evaluation of non-small-cell lung cancer.  Am J Respir Crit Care Med . 1997;  156 320-332
  • 7 Swensen S, Silverstein M, Ilstrup D. The probability of malignancy in solitary pulmonary nodules. Application to small radiologically indeterminate nodules.  Arch Int Med . 1997;  157 849-855
  • 8 Lillington G. Management of solitary pulmonary nodules.  Dis Mon . 1991;  37 271-318
  • 9 Cummings S R, Lillington G A, Richard R J. Estimating the probability of malignancy in solitary pulmonary nodules. A Bayesian approach.  Am Rev Respir Dis . 1986;  134 449-4452
  • 10 Quint L, Tummala S, Brisson L. Distribution of distant metastases from newly diagnosed non-small cell lung cancer.  Ann Thorac Surg . 1996;  62 246-250
  • 11 Silvestri G, Littenburg B, Colice G. The clinical evaluation for detecting metastatic lung cancer: A meta-analysis.  Am J Respir Crit Care Med . 1995;  152 225-230
  • 12 Hillers T, Sauve M, Guyatt G. Analysis of published studies on the detection of extrathoracic metastases in patients presumed to have operable non-small cell lung cancer.  Thorax . 1994;  49 14-19
  • 13 Margolis M. Non-small cell lung cancer: Clinical aspects, diagnosis, staging, and natural history. In: Fishman A, Elias J, Grippi M, et al., eds. Fishman's Pulmonary Diseases and Disorders New York: McGraw-Hill 1998: 1759-1781
  • 14 Salazar A, Westcott J. The role of transthoracic needle biopsy for the diagnosis and staging of lung cancer.  Clin Chest Med . 1993;  14 99-110
  • 15 Odell M, Reid K. Does percutaneous fine-needle aspiration biopsy aid in the diagnosis and surgical management of lung masses?.  Can J Surg . 1999;  42 297-301
  • 16 Lawrence V, Hilsenbeck S, Mulrow C. Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery.  J Gen Int Med . 1995;  10 671-678
  • 17 Zuger J. Positron emission tomography in lung imaging. ACCP Pulmonary Crit Care Update 1999: 15
  • 18 Swensen S, Brown L, Colby T. Pulmonary nodules. CT evaluation of enhancement with iodinated contrast material.  Radiology . 1995;  194 393
  • 19 Korst R J, Ginsberg R J, Ailawadi M. Lobectomy improves ventilatory function in selected patients with severe COPD.  Ann Thorac Surg . 1998;  66 898-902
  • 20 Arroglia A, Matthay R. Thr role of bronchoscopy in lung cancer.  Clin Chest Med . 1993;  14 87-98
  • 21 Wallace J, Deutsch A. Flexible fiberoptic bronchoscopy and percutaneous needle lung aspiration for evaluating the solitary pulmonary nodule.  Chest . 1982;  81 665-671
  • 22 McLoud T, Bourgouin P, Greenberg R. Bronchogenic carcinoma: Analysis of staging in the mediastinum with CT by correlative lymph node mapping and sampling.  Radiology . 1992;  182 319-323
  • 23 Kernstine K, Stanford W, Mullan B. PET, CT and MRI with Combidex for mediastinal staging in non-small cell lung carcinoma.  Ann Thorac Surg . 1999;  68 1022-1028
  • 24 Scott W, Shepherd J, Gambhir S. Cost-effectiveness of FDG-PET for staging non-small cell lung cancer: A decision analysis.  Ann Thorac Surg . 1998;  66 1876-1885
  • 25 Porte H, Ernst O, Delebecq T. Is computed tomography guided biopsy still necessary for the diagnosis of adrenal masses in patients with resectable non-small-cell lung cancer?.  Eur J Cardiothorac Surg . 1999;  15 597-601
  • 26 Erasmus J, Patz E, McAdams H. Evaluation of adrenal masses in patients with bronchogenic carcinoma using 18F-fluorodeoxyglucose positron emission tomography.  Am J Roentgenol . 1997;  168 129-132
  • 27 Mansour K, Wanna F. Extended resection of bronchial carcinoma in the superior pulmonary sulcus. In: Shields TW, LoCicero J, Ponn RB, eds. General Thoracic Surgery New York: Lippincott Williams & Wilkins; 2000: 467
  • 28 Mountain C. Revisions in the international system for staging lung cancer.  Chest . 1997;  111 1710-1717
  • 29 Solpen A, Carr J J, Hatabu H. Magnetic resonance imaging of the thorax. In: Shields TW, LoCicero J, Ponn RB, eds. General Thoracic Surgery New York: Lippincott Williams & Wilkins; 2000: 187
  • 30 Heelan R T, Demas B E, Caravelli J F. Superior sulcus tumors: CT and MR imaging.  Radiology . 1989;  170 637-641
  • 31 Schenk D, Bower J, Bryan C. Transbronchial needle aspiration staging of bronchogenic carcinoma.  Am Rev Respir Dis . 1986;  134 146-148
  • 32 Shannon J, Bude R, Orens J. Endobronchial ultrasound-guided needle aspiration of mediastinal adenopathy.  Am J Respir Crit Care . 1996;  153 1424-1430
  • 33 Kondo D, Imaizumi M, Abe T. Endoscopic ultrasound examination for mediastinal lymph node metastases of lung cancer.  Chest . 1990;  983
  • 34 Hunerbein M, Ghadimi B, Haensch W. Transesophageal biopsy of mediastinal and pulmonary tumors by means of endoscopic ultrasound guidance.  J Thorac Cardiovasc Surg . 1998;  116 554-559
  • 35 Fritscher-Ravens A, Petrasch S, Eeinacher-Schick A. Diagnostic value of endoscopic ultrasonography-guided fine-needle aspiration cytology of mediastinal masses in patients with intrapulmonary lesions and nondiagnostic bronchoscopy.  Respiration . 1998;  66 150-155
  • 36 Silvestri G, Hoffman B, Bhutani M. Endoscopic ultrasound with fine-needle aspiration in the diagnosis and staging of lung cancer.  Ann Thorac Surg . 1996;  61 1441-1446
  • 37 Ichinose Y, Hara N, Ohta M. Preoperative examination to detect distance metastasis is not advocated for asymptomatic patient with stages 1 and 2 non-small cell lung cancer.  Chest . 1989;  96 1104
  • 38 Algra P, Bloem J, Tissing H. Detection of vertebral metastases: Comparison between MR imaging and bone scintigraphy.  Radiographics . 1991;  11 219-232
  • 39 Rosenthal D. Radiologic diagnosis of bone metastases.  Cancer . 1997;  80 1595-1607
  • 40 Gosfield E, Alavi A, Kneeland B. Comparison of radionuclide bone scans and magnetic resonance imaging in detecting spinal metastases.  J Nucl Med . 1993;  34 2191-2198
  • 41 Bury T, Barreto A, Daenen F. Fluorine-18 deoxyglucose positron emission tomography for the detection of bone metastases in patients with non-small cell lung cancer.  Eur J Nucl Med . 1998;  25 1244-1247
  • 42 Bury T, Dowlati A, Paulus P. Staging of non-small-cell lung cancer by whole-body fluorine-18 deoxyglucose positron emission tomography.  Eur J Nucl Med . 1996;  23 204-206
  • 43 Marom E, McAdams H, Erasmus J. Staging non-small cell lung cancer with whole-body PET.  Radiology . 1999;  212 803-809
  • 44 Shreve P, Steventon R, Deters E. Oncologic diagnosis with 2-[fluorine-18]fluoro-2-deoxy-D-glucose imaging: Dual-head coincidence gamma camera versus positron emission tomographic scanner.  Radiology . 1998;  207 431-437
  • 45 Spiro S. Bronchial tumors. In: Brewis R, Corrin B, Geddes DM, Gibson GJ, eds. Respiratory Medicine New York: W.B. Saunders 1995: 924-961
  • 46 Light R, Eozan Y, Ball W. Cells in pleural fluid: Their value in differential diagnosis.  Arch Int Med . 1973;  132 84-90
  • 47 Chernow B, Sahn S. Carcinomatous involvement of the pleura.  Am J Med . 1977;  63 695-702
  • 48 Boutin C, Viallat J, Cargnino P. Thoracoscopy in malignant pleural effusions.  Am Rev Respir Dis . 1981;  124 588-592
  • 49 Menzies R, Charbonneau M. Thoracoscopy for the diagnosis of pleural disease.  Ann Int Med . 1991;  114 271-276
  • 50 Peretti-Viton P, Margain D, Murayama N. Brain metastases.  J Neuroradiol . 1991;  18 161-172
  • 51 Patchell P, Tibbs P, Walsh J. A randomized trial of surgery in the treatment of single brain metastases.  N Engl J Med . 1990;  322 494-500
  • 52 Pomeranz S, Soila K, Tobias J. Sensitivity of MRI in metastatic neoplasia: A case report.  Magn Reson Imag . 1985;  3 291-293
  • 53 Earnest F, Ryu J, Miller G. Suspected non-small cell lung cancer: Incidence of occult brain and skeletal metastases and effectiveness of imaging for detection-pilot study.  Radiology . 1999;  211 137-145
  • 54 Yokoi K, Kamiya N, Matsuguma H. Detection of brain metastases in potentially operable non-small cell lung cancer: A comparison of CT and MRI.  Chest . 1999;  115 714-719
    >