Der Pneumologe

, 5:187 | Cite as

Diagnostik des Bronchialkarzinoms

CME Weiterbildung • Zertifizierte Fortbildung

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 das Thorax-CT ergänzt. Eine Probe zur histologischen bzw. zytologischen Diagnostik sollte 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. Die Positronenemissionstomographie besitzt in der Diagnostik des Bronchialkarzinoms eine gesicherte Evidenz. Sie dient einerseits der Abklärung mediastinaler Lymphome und andererseits dem extrathorakalen Staging. Dieses sollte die häufigen Metastasierungsorte Nebennieren, Leber, ZNS und Skelett umfassen.

Schlüsselwörter

Bronchialkarzinom Diagnostik Bronchoskopie PET TNM-Stadien 

Diagnostic evaluation of lung cancer

Abstract

Lung cancer is the fourth most common cause of death in Germany. Symptoms are mainly nonspecific and often develop at a late stage. The diagnostic procedure begins with clinical history and examination. X-ray of the thorax is the basis of imaging and is supplemented by a computed tomography (CT) scan of the thorax. A biopsy for histological or cytological evaluation should be performed by the least invasive method, usually bronchoscopy. Supplemented by modern techniques such as narrow-band imaging, endobronchial ultrasound and electromagnetic navigation, bronchoscopy plays an important role in the diagnostic procedure. Positron emission tomography (PET) provides reliable evidence of lung cancer. It can be used for further evaluation of mediastinal lymphadenopathy and also supplements extrathoracical staging. This should cover the most prevalent organs of metastasis, namely the adrenal glands, liver, central nervous system and bones.

Keywords

Lung cancer Staging Bronchoscopy PET TNM classification 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Bandi V, Lunn W, Ernst A et al. (2008) Ultrasound vs. computed tomography in detecting chest wall invasion by tumor: a prospective study. Chest (in press)Google Scholar
  2. 2.
    Bolliger CT, Perruchoud AP (1998) Functional evaluation of the lung resection candidate. Eur Resp J 11: 198–212CrossRefGoogle Scholar
  3. 3.
    Canadian Lung Oncology Group (2001) Investigating extrathoracic metastatic disease in patients with apparently operable lung cancer. Ann Thorax Surg 71: 425–433CrossRefGoogle Scholar
  4. 4.
    Detterbeck FC, Jantz MA, Wallace M et al. (2007) Invasive mediastinal staging of lung cancer. ACCP evidenced-based clinical practice guidelines, 2nd edn. Chest 132: 202S–220SPubMedCrossRefGoogle Scholar
  5. 5.
    Eberhardt R, Anantham D, Herth F et al. (2007) Electromagnetic navigation diagnostic bronchoscopy in peripheral lung lesions. Chest 131: 1800–1805PubMedCrossRefGoogle Scholar
  6. 6.
    Goldstraw P, Crowley J, Chansky K et al. (2007) The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of Malignant Tumours. J Thoracic Oncol 2: 706–714Google Scholar
  7. 7.
    Gould MK, Flechter J, Iannettoni MD et al. (2007) Evaluation of patients with pulmonary nodules: when is it lung cancer? ACCP evidenced-based clinical practice guidelines, 2nd edn. Chest 132: 108S–130SPubMedCrossRefGoogle Scholar
  8. 8.
    Herth F, Becker HD (2003) EBUS for early cancer detection. J Bronchol 115: 249–253CrossRefGoogle Scholar
  9. 9.
    Herth F, Ernst A, Becker HD (2002) EBUS guided transbronchial lung biopsy in solitary pulmonary nodules and peripheral lesions. Eur Res J 20: 972–975CrossRefGoogle Scholar
  10. 10.
    Herth FJF, Eberhardt R, Vilmann P et al. (2006) Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes. Thorax 61: 795–798PubMedCrossRefGoogle Scholar
  11. 11.
    Hintze C, Biederer J, Wenz HW et al. (2006) MRI in staging of lung cancer. Radiologe 46: 251–254PubMedCrossRefGoogle Scholar
  12. 12.
    Kormas P, Bradshaw JR, Jeyasingham K (1992) Preoperative computed tomography of the brain in non-small cell bronchogenic carcinoma. Thorax 47: 106–108PubMedCrossRefGoogle Scholar
  13. 13.
    Lardinois D, Weder W, Hany TF et al. (2003) Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med 348: 2500–2507PubMedCrossRefGoogle Scholar
  14. 14.
    Mountain CF, Dresler CM (1997) Regional lymph node classification for lung cancer staging. Chest 111: 1718–1723PubMedCrossRefGoogle Scholar
  15. 15.
    Rivera MP, Mehta AC (2007) Initial diagnosis of lung cancer. ACCP evidenced-based clinical practice guidelines, 2nd edn. Chest 132: 131S–148SPubMedCrossRefGoogle Scholar
  16. 16.
    Silvestri GA, Littenberg B, Colice GL (1995) The clinical evaluation for detecting metastatic lung cancer. Am J Respir Crit Care Med 152: 225–230PubMedGoogle Scholar
  17. 17.
    Silvestri GA, Gould MK, Margolis ML et al. (2007) Noninvasive staging of Non-small cell lung cancer. ACCP evidenced-based clinical practice guidelines, 2nd edn. Chest 132: 178S–201SPubMedCrossRefGoogle Scholar
  18. 18.
    Spiro SG, Gould MK, Colice GL (2007) Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes. ACCP evidenced-based clinical practice guidelines, 2nd edn. Chest 132: 149S–160SPubMedCrossRefGoogle Scholar
  19. 19.
    Wittekind CH, Wagner G (1997) UICC TNM-Klassifikation maligner Tumoren. Springer, Berlin Heidelberg New YorkGoogle Scholar

Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Pneumologie und BeatmungsmedizinThoraxklinik am Universitätsklinikum HeidelbergHeidelbergDeutschland

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