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Current investigative modalities for detecting and staging lung cancers: a comprehensive summary

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Abstract

This narrative review compares the advantages and drawbacks of imaging and other investigation modalities which currently assist with lung cancer diagnosis and staging, as well as those which are not routinely indicated for this. We examine plain film radiography, computed tomography (CT) (alone, as well as in conjunction with positron emission tomography (PET)), magnetic resonance imaging (MRI), ultrasound, and newer techniques such as image-guided bronchoscopy (IGB) and robotic bronchoscopy (RB). While a chest X-ray is the first-line imaging investigation in patients presenting with symptoms suggestive of lung cancer, it has a high positive predictive value (PPV) even after negative X-ray findings, which calls into question its value as part of a potential national screening programme. CT lowers the mortality for high-risk patients when compared to X-ray and certain scoring systems, such as the Brock model can guide the need for further imaging, like PET-CT, which has high sensitivity and specificity for diagnosing solitary pulmonary nodules as malignant, as well as for assessing small cell lung cancer spread. In practice, PET-CT is offered to everyone whose lung cancer is to be treated with a curative intent. In contrast, MRI is only recommended for isolated distant metastases. Similarly, ultrasound imaging is not used for diagnosis of lung cancer but can be useful when there is suspicion of intrathoracic lymph node involvement. Ultrasound imaging in the form of endobronchial ultrasonography (EBUS) is often used to aid tissue sampling, yet the diagnostic value of this technique varies widely between studies. RB is another novel technique that offers an alternative way to biopsy lesions, but further research on it is necessary. Lastly, thoracic surgical biopsies, particularly minimally invasive video-assisted techniques, have been used increasingly to aid in diagnosis and staging.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, L14 3PE, UK

    Bejoy Philip & Amer Harky

  2. Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK

    Anchal Jain

  3. St. George’s University of London, London, UK

    Milosz Wojtowicz

  4. Department of Medicine, Royal Sussex County Hospital, Brighton, UK

    Inayat Khan

  5. School of Medicine, University of Liverpool, Liverpool, UK

    Calum Voller

  6. School of Medicine, Swansea University, Swansea, UK

    Roshni S. K. Patel

  7. School of Medicine, University of Central Lancashire, Preston, UK

    Darbi Elmahdi

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Philip, B., Jain, A., Wojtowicz, M. et al. Current investigative modalities for detecting and staging lung cancers: a comprehensive summary. Indian J Thorac Cardiovasc Surg 39, 42–52 (2023). https://doi.org/10.1007/s12055-022-01430-2

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