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Lung Cancer Staging Methods: A Practical Approach

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Interventions in Pulmonary Medicine

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Abstract

The dilemma that many clinicians face is being able to recognize which patients have a higher likelihood of developing lung cancer and which biopsy modality would provide an accurate diagnosis and stage, while limiting the risk to the patient. Determining the extent of disease is crucial for both prognosis and therapy.

The evaluation should begin with a thorough history and physical exam followed by radiographic imaging of the chest. Initial studies usually include a chest x-ray, but often progress to a computed tomography (CT) of the chest with further extra-thoracic imaging as dictated by symptoms. Following the CT of the chest, positron emission tomography-computed tomography (PET-CT) can be used to evaluate for radiographic staging, possible targets for biopsy, and identify occult metastatic disease.

Once a target is identified, minimally invasive needle techniques to diagnose and stage the mediastinum have become the standard of care. If biopsy by minimally invasive techniques is negative, it should be followed by surgical biopsy/staging. Metastatic disease outside of the chest identified on CT chest and/or PET-CT should be further investigated with biopsy as this would provide both a diagnosis and staging in one procedure. Mutational analysis of a patient’s tumor has rapidly become standard of care during the diagnostic process so that patients can receive the most appropriate therapy available.

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Abbreviations

ACCP:

American College of Chest Physicians

ALK:

Anaplastic lymphoma kinase

BRAF:

B-Raf proto-oncogene serine/threonine kinase

CP-EBUS:

curvilinear probe endobronchial ultrasound

CT:

Computed tomography

CXR:

Chest x-ray

EBUS-FNA:

Endobronchial ultrasound fine needle aspiration

EBUS-TBNA:

Endobronchial ultrasound with transbronchial needle aspiration

ECM:

Extended cervical mediastinoscopy

EGFR:

Epidermal growth factor receptor

ENB:

Electromagnetic navigation bronchoscopy

EUS-FNA:

Endoscopic ultrasound fine needle aspiration

FDG:

18F-Fluorodeoxyglucose

HHM:

Humoral hypercalcemia of malignancy

LDCT:

Low dose computed tomography

MET:

Mesenchymal epithelial transition

MPE:

Malignant pleural effusion

MRI:

Magnetic resonance imaging

NTRK:

Neurotrophic tyrosine receptor kinase

NCCN:

National comprehensive cancer network

NLST:

National lung cancer screening trial

NPV:

Negative predictive value

NSCLC:

Non-small cell lung cancer

PD-L1:

Programmed death ligand 1

PE:

Pulmonary embolism

PET-CT:

Positron emission tomography-computed tomography

PPL:

Peripheral pulmonary lesions

PPV:

Positive predictive value

RB:

Robotic bronchoscopy

RCT:

Randomized controlled trials

RET:

Rearranged during transfection

ROS1:

c-Ros oncogene 1

ROSE:

Rapid onsite evaluation

RP-EBUS:

Radial probe endobronchial ultrasound

SCC:

Squamous cell carcinoma

SCM:

Standard cervical mediastinoscopy

SIADH:

Syndrome of inappropriate antidiuretic hormone secretion

SUV:

Standardized uptake value

TBNA:

Transbronchial needle aspiration

TNM:

Tumor node metastasis

TTNA:

Transthoracic needle aspiration

USPSTF:

United States preventive services task force

VATS:

Video-assisted thoracoscopic surgery

VBN:

Virtual bronchoscopic navigation

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Authors and Affiliations

  1. Department of Medicine, Division of Pulmonary and Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA

    Travis L. Ferguson, Tejaswi R. Nadig & Gerard A. Silvestri

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  2. Tejaswi R. Nadig
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  3. Gerard A. Silvestri
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Correspondence to Gerard A. Silvestri .

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  1. Interventional Pulmonary Department Hospital, Universitari de Bellvitge Hospitalet de Llobregat, Barcelona, Spain

    José Pablo Díaz-Jiménez

  2. School of Medicine, National University of Mar del Plata, Buenos Aires, Argentina

    Alicia N. RodrĂ­guez

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Ferguson, T.L., Nadig, T.R., Silvestri, G.A. (2023). Lung Cancer Staging Methods: A Practical Approach. In: Díaz-Jiménez, J.P., Rodríguez, A.N. (eds) Interventions in Pulmonary Medicine. Springer, Cham. https://doi.org/10.1007/978-3-031-22610-6_28

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