Der Internist

, Volume 52, Issue 2, pp 138–145

Staging des Bronchialkarzinoms

Schwerpunkt
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Zusammenfassung

Das Bronchialkarzinom ist die vierthäufigste Todesursache in Deutschland. Symptome sind oft unspezifisch und treten häufig erst spät auf. An erster Stelle der Diagnostik stehen die Anamnese und klinische Untersuchung. Die Thoraxröntgenaufnahme ist die Grundlage der bildgebenden Diagnostik und wird durch die Computertomographie des Thorax ergänzt, üblicherweise mit Kontrastmittelverstärkung. Anschließend sollte eine Probe zur histologischen bzw. zytologischen Diagnostik durch die am wenigsten invasive Methode durchgeführt werden, zumeist die Bronchoskopie. Ergänzt durch neuere Techniken wie Narrow-Band-Imaging, endobronchialen Ultraschall und elektromagnetische Navigation nimmt sie in der gesamten Diagnostik einen wichtigen Stellenwert ein. In Abhängigkeit von den individuellen Therapieoptionen erfolgt das weitere Staging. Die Positronenemissionstomographie besitzt in der Diagnostik des Bronchialkarzinoms eine gesicherte Evidenz. Sie dient einerseits der Abklärung mediastinaler Lymphknoten und andererseits dem extrathorakalen Staging. Dieses sollte die häufigen Metastasenorte Nebennieren, Leber und Skelett umfassen. Insbesondere sollte eine Magnetresonanztomographie des Gehirns erfolgen.

Schlüsselwörter

Lungenkarzinom Diagnostik Bronchoskopie Positronenemissionstomographie TNM-Stadien 

Diagnostic evaluation of lung cancer

Abstract

Lung cancer is the fourth rate cause of death in Germany. Symptoms are mainly unspecific and develop lately. Clinical history and examination come in first place of the diagnostic procedure. X-ray of the thorax is the basis of imaging and is completed by a CT scan of the chest. Afterwards, a biopsy for histological or cytological evaluation should be performed by the least invasive method, mostly bronchoscopy. Supplemented by modern techniques as narrow-band-imaging, endobronchial ultrasound and electromagnetic navigation, bronchoscopy takes a high value in the diagnostic procedure. Further staging is performed depending upon individual therapeutic options. Positron-emission-tomography has good evidence in lung cancer. On the one hand it serves for further evaluation of mediastinal lymphadenopathy and on the other it can complete extrathoracical staging. This should comprise the most prevalent localizations of metastasis, the adrenal glands, liver, and bones, while especially the brain should be imaged with usage of magnet resonance imaging.

Keywords

Lung cancer Diagnostics Bronchoscopy Positron-emission-tomography TNM-classification 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Pneumologie und BeatmungsmedizinThoraxklinik, Universitätsklinikum HeidelbergHeidelbergDeutschland
  2. 2.Diagnostische und Interventionelle Radiologie mit NuklearmedizinThoraxklinik, Universitätsklinikum HeidelbergHeidelbergDeutschland

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