The Future in Diagnosis and Staging of Lung Cancer

Abstract

Surgical techniques remain central to the diagnosis and staging of lung cancer. Clinical situations which invoke the role of surgery include the diagnosis of solitary pulmonary masses, staging of the mediastinum, restaging of the mediastinum and the assessment of resectability. The techniques available include cervical mediastinoscopy, anterior mediastinotomy, video-assisted thoracoscopy and different procedures for intra-operative mediastinal lymph node assessment including systematic nodal dissection, lobe-specific nodal dissection and sentinel node mapping. The staging of lung cancer is continuously evolving as technological advances combine with clinical advances to better stratify patients into treatment and prognostic categories and alter pre-operative investigation algorithms. Although most of the surgical techniques have been around for many years, it is their application in future which is likely to change. The increasing use of positron emission tomography/computed tomography fusion imaging is raising the proportion of patients being shown to have additional lesions that could contraindicate surgical treatment but which require tissue confirmation to exclude a false-positive examination. Many such lesions are amenable to the expanding techniques available to the interventional endoscopist. The relationship between the surgeon and the endoscopist must become closer to ensure that the appropriate technique is used at each point in the patient’s pathway. The future of surgical techniques will be driven by: (1) developments in screening and imaging, with a likelihood that more early stage cancers will present and may be amenable to minimally invasive surgical approaches with the possibility of a role for robotics and nanotechnology; (2) improvements in neoadjuvant therapies which will demand flawless mediastinal staging and restaging; (3) advances in molecular biology which, whilst currently requiring that surgery provide samples of tumour and lymph node tissue to fully characterize the disease, do hold the promise that ever smaller amounts of tissue will be required and that eventually the genetic fingerprint will provide a biological ultrastaging to perhaps supersede anatomical staging.

Endoscopic Ultrasound Reduces Surgical Mediastinal Staging in Lung Cancer

“…In patients with non-small cell lung cancer (NSCLC) in whom there is no evidence for extrathoracic metastasis, assessment of the mediastinal lymph nodes for malignancy is of utmost importance (1)(2)(3)(4). Mediastinal staging by surgical techniques (mainly cervical mediastinoscopy) is considered the gold standard (5,6), although the sensitivity to detect malignant lymph node invasion was shown earlier to be only 81% (7).…”

Pulmonary Blastoma with Submandibular, Scrotum and Adrenal Metastases: Case Report

“…Since pulmonary blastoma progresses rapidly in a short period of time, early detection [20] and careful staging are imperative [21,22]. Treatment strategy should be defined by a multidisciplinary team that includes a pulmonologist, an oncologist, a thoracic surgeon and a general surgeon.…”

Carcinoma pulmonar no microcítico: avances recientes

“…La mediastinoscopia efectuada antes de la cirugía es la prueba de referencia para la evaluación de los ganglios linfáticos en cualquier paciente con CPNM 25,26 ; se lleva a cabo a través de una pequeña incisión transversal realizada en la zona inferior del cuello, a través de la cual se introduce el endoscopio para explorar la zona y obtener muestras de biopsia de los ganglios linfáticos. La ecografía endobronquial utiliza un broncoscopio y la ecografía para localizar y biopsiar los…”

“…Aunque es un procedimiento ligeramente menos invasivo, la ecografía endobronquial suelen llevarla a cabo especialistas en neumología intervencionista, independientemente de la cirugía en sí misma 26,27 .…”