Preoperative Evaluation Of Lung Cancer Research Articles

The Evolving Landscape of Lung Cancer Surgical Resection: An Update for Radiologists With Focus on Key Chest CT Findings.

Evolution of the multimodality management of early lung cancer, including progress in surgical techniques, has introduced the possibility of resection for lung cancer cases that historically were considered unresectable (e.g., select cases of T4 disease and oligometastatic disease). However, the TNM classification does not uniformly correlate with lung cancer operability and resectability. Radiologic evaluation is therefore critical in identifying patients' suitability to undergo lung cancer resection and in guiding the selection of a surgical approach from among a range of such approaches, including wedge resection, segmentectomy, lobectomy, bilobectomy, and pneumonectomy. The radiologist must understand the available surgical options, along with their advantages and disadvantages, and provide a report that includes critical information on tumor size, location, and extension and anatomic relations that may influence the surgical technique. Preoperative CT findings may also help predict expected postoperative lung function and the associated impact on the postoperative course of the patient. This article reviews the role of chest CT in the preoperative evaluation of lung cancer, focusing on the key CT findings that help direct surgical decision making in the context of an expanding range of patients who may be considered candidates for resection.

Visibility of the hilar lymph nodes using advanced virtual monoenergetic low-keV images for preoperative evaluation of lung cancer

The purpose of our study was to evaluate the visibility of the hilar lymph nodes (LNs) using advanced virtual monoenergetic low-keV images compared with early-phase contrast-enhanced CT. Dual energy contrast-enhanced CT was performed for pre-operative evaluation of lung cancer at 20 and 60 s after administration of contrast media in 50 patients (32 males and 18 females; mean age, 69 years). Five kinds of images (A: 20 s/120 kV; B: 60 s/40 keV; C: 60 s/50 keV; D: 60 s/120 kV; E: 60 s/100 kV) were reconstructed. We measured the CT number of the bilateral main pulmonary arteries (PAs), pulmonary veins (PVs) and hilar LNs, and evaluated the differences in CT number (Hounsfield units, HUs) between the PA/PV and LNs (PA-LN and PV-LN contrast). Artifacts from the superior vena cava (SVC) were also evaluated. The mean PA-LN contrast (HU) was 415 in image group A, 299 in B, 180 in C, 80 in D, and 100 in E. The mean PV-LN contrasts in each group were 306, 287, 177, 78, and 99, respectively. Image group B showed the second highest PA-LN contrast following image group A. There was no significant difference in the PV-LN contrast between image groups A and B. The PA-LN and PV-LN contrasts of image groups B and C were significantly higher than those of E. SVC artifacts were lower in the delayed-phase images (Group B-E) than in Group A. To evaluate the hilar LNs with a single image series, advanced virtual monoenergetic 40-keV imaging at the delayed 60-s phase seems to be the most valuable. Advanced virtual monoenergetic image is useful for evaluation of both hilar LNs and tumors in the delayed phase without artifact derived from the streak artifact from dense contrast media in the SVC.

Invited Commentary

Faris and associates [1Faris N. Yu X. Sareen S. et al.Preoperative evaluation of lung cancer in a community health care setting.Ann Thorac Surg. 2015; 100: 394-400Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar] report on lung cancer care delivery in a 2-hospital health system that provides care for patients across several Southern states. Their overall findings and conclusions mirror those revealed through analyses of national cancer registries—there are significant gaps in the quality of lung cancer care. The authors plan to bridge this gap with a multidisciplinary team of thoracic oncology experts and systems engineers. An important limitation of this study is that the denominator consists of patients selected to undergo pulmonary resection. The authors recognize this limitation and intend to evaluate all patients with suspected or confirmed non-small cell lung cancer in the future. This key aspect of their future plans deserves emphasis—the authors intend to pursue a disease-based rather than treatment-based approach to quality improvement. A disease-based approach to quality improvement is impactful in two ways. First, by moving “proximally” on the cancer care continuum, more individuals can reap the potential benefits of quality improvement. A simple, linear conceptualization of the cancer care continuum is prevention, screening, diagnosis/staging, treatment, and survivorship/end-of-life care. More “proximal” aspects of the care continuum have a larger denominator. For example, up to 94 million former or current smokers are eligible to undergo evidence-based smoking cessation or lung cancer screening, or both. By contrast, there are approximately 240,000 newly diagnosed lung cancer patients each year, of which approximately 50,000 undergo surgical therapy. Ensuring high-quality prevention and screening will affect a greater number of people than those undergoing surgical therapy. However, impact cannot and should not be judged by numbers alone. Moving “proximally” on the cancer care continuum can reveal other important detrimental departures from optimal care. For instance, patients with suspected or confirmed non-small cell lung cancer should undergo rigorous preoperative nodal staging. Many would agree that an overstaged patient falsely presumed to have locally advanced disease and deprived a curative-intent resection is a significant departure from optimal care. Evaluating only surgical patients precludes an understanding of how many patients are inappropriately denied an opportunity for a cure. Moving “proximally” towards a disease-based approach to quality improvement allows for such efforts to better realize their potential of positively influencing individuals and the general population. Preoperative Evaluation of Lung Cancer in a Community Health Care SettingThe Annals of Thoracic SurgeryVol. 100Issue 2PreviewWe examined the presurgical evaluation of suspected lung cancer patients in a community-based health care system to establish current benchmarks of care that will lay the groundwork for an evidence-based quality improvement project. Full-Text PDF

Preoperative Evaluation of Lung Cancer in a Community Health Care Setting

We examined the presurgical evaluation of suspected lung cancer patients in a community-based health care system to establish current benchmarks of care that will lay the groundwork for an evidence-based quality improvement project. We retrospectively reviewed clinical records of all recipients of lung resection at two institutions, and classified all lung cancer relevant procedures into five "nodal points": lesion detection, diagnostic biopsy, radiologic staging, invasive staging, and treatment. We analyzed the frequency of passage through each nodal point, the time intervals between nodal points, and the use of staging modalities. Of 614 eligible patients, 92% had lung cancer, 5% had a non-lung primary tumor, 3% had a benign lesion. Six percent received preoperative therapy; 39% ofresections were minimally invasive. Ninety-eight percent of patients had a preoperative computed tomography (CT) scan, 27% had no preoperative diagnostic procedure, 22% had no preoperative positron emission tomography (PET)/CT scans, and 88% had no invasive preoperative staging test. Only 10% had trimodality staging with CT, PET/CT, and invasive staging. Twenty-one percent of patients who had an invasive staging test had mediastinal nodal metastasis at resection. The median duration (interquartile range) from initial lesion identification to resection was 84 days (43 to 189) days; from lesion identification to diagnostic biopsy, 28 days (7 to 96); and from diagnostic biopsy to surgery, 40 days (26 to 69). There is opportunity for improvement in the thoroughness, accuracy, and timeliness of preoperative evaluation of suspected lung cancer patients in this community cohort. Better coordination of care may significantly improve these benchmarks.

Lung cancer with scattered consolidation: detection of new independent radiological category of peripheral lung cancer on thin-section computed tomography

Ground glass opacity (GGO) on thin-section computed tomography (CT) has been reported to be a favourable prognostic marker in lung cancer, and the size or area of GGO is commonly used for preoperative evaluation. However, it can sometimes be difficult to evaluate the status of GGO. A retrospective study was conducted on 572 consecutive patients with resected lung cancer of clinical stage IA between 2004 and 2011. All patients underwent preoperative CT and their radiological findings were reviewed. The areas of consolidation and GGO were evaluated for all lung cancers. Lung cancers were divided into three categories on the basis of the status of GGO: GGO, part solid and pure solid. Lung cancers in which it was difficult to measure GGO were selected and their clinicopathological features were investigated. Seventy-one (12.4%) patients had lung cancer in whom it was difficult to measure GGO. In all these cases, consolidation and GGO were not easily measured because of their scattered distribution. In this cohort, nodal metastases were not observed at all. The frequency of other pathological factors, such as lymphatic and/or vascular invasion, was significantly lower (P < 0.0001). This new category of lung cancer with scattered consolidation on thin-section CT scan tended to be pathologically less invasive. When lung cancer has GGO and is difficult to measure because of a scattered distribution, its prognosis could be favourable regardless of the area of GGO. This new category could be useful for the preoperative evaluation of lung cancer.

Preoperative evaluation of lung cancer: predicting the impact of surgery on physiology and quality of life

To summarize the best clinical evidence published in the last year and regarding the functional evaluation and the residual quality of life after lung resection in patients with lung cancer. Recent evidences have shown that predicted postoperative forced expiratory volume in 1 s is not a reliable predictor of complications in patients with obstructive pulmonary disease and that carbon monoxide lung diffusion capacity predicts complications even in patients with normal forced expiratory volume in 1 s. Maximal stair-climbing test appears to discriminate better between complicated and noncomplicated patients compared with traditional split-lung function measures. Patients unable to climb 12 m have 2.5-fold and 13-fold higher complications and mortality rates compared with those able to climb 22 m. Quality of life has been shown to decrease in the first month but to return to preoperative values after 3 months in most of the patients after lung resection. Carbon monoxide lung diffusion capacity and stair-climbing test should be performed routinely in all lung-resection candidates. In those with poor exercise tolerance in stair-climbing test or exercise oxygen desaturation, or candidates to pneumonectomy, the measurement of VO2max is recommended. Quality of life should always be assessed through specific instruments and not inferred by traditional functional tests.

Synchronous Roentgenographically Occult Lung Carcinoma in Patients With Resectable Primary Lung Cancer

To assess the prevalence of synchronous roentgenographically occult lung carcinoma (ROLC) in patients with resectable roentgenographically visible lung cancer (RVLC). Patients undergoing surgery for RVLC in the same University Hospital were prospectively evaluated before surgery by fluorescence bronchoscopy under local anesthesia to detect synchronous ROLC. All abnormal areas, with the exception of the RVLC, had biopsies made. From June 1996 to January 1999, 43 patients (male/female ratio: 1.7/1.0) were evaluated before lobectomy (n = 34) or pneumonectomy (n = 10) for 44 primary RVLC. There were 10 T1N0, 19 T2N0, 1 T1N1, 9 T2N1, 1 T3N0, 3 T1N2, and 1 T3N1 lesions. The histologic type was mainly squamous carcinoma (n = 21) and adenocarcinoma (n = 14). All but two patients were smokers or ex-smokers (mean +/- SD, 48 +/- 28 pack-years). A total of 177 endobronchial biopsies were performed (4.1 +/- 2.5); 8 were too small to be informative, 43 showed non-preneoplastic alterations, and 50 were normal. There were 7 basal cell hyperplasias, 56 metaplasias, 9 dysplasias, and 4 carcinomas in situ (CIS). All the dysplasias and CIS lesions were observed in eight subjects. The synchronous CIS were treated by surgery (n = 1) or localized therapeutic modalities (n = 3). The high prevalence of synchronous early lung cancers (9.3%) as well as metaplasia and dysplasia in this series of patients with resectable RVLC suggests that fluorescence bronchoscopy may be a useful adjunct in the preoperative evaluation of lung cancer.

Whole-body 18F-fluorodeoxyglucose positron emission tomography in preoperative evaluation of lung cancer : Lewis P, Griffin S, Marsden P, Gee T, Nunan T, Malsey M et al. Department of Radiology, Darmouth-Hitchcock Medical Center, One Medical Centre Drive, Lebanon, NH 03756. Lancet 1994;344:1265–1266

Whole-body 18F-fluorodeoxyglucose positron emission tomography in preoperative evaluation of lung cancer : Lewis P, Griffin S, Marsden P, Gee T, Nunan T, Malsey M et al. Department of Radiology, Darmouth-Hitchcock Medical Center, One Medical Centre Drive, Lebanon, NH 03756. Lancet 1994;344:1265–1266

Whole-body 18F-fluorodeoxyglucose positron emission tomography in preoperative evaluation of lung cancer

Despite use of computed tomography, some lung cancer patients are found to have unresectable disease at surgery, or they present early with metastases. We studied whether whole-body positron emission tomography (PET) with 18F-fluorodeoxyglucose (18FDG) would improve the preoperative detection of metastases. We retrospectively analysed 34 patients with "operable" non-small-cell lung cancer who underwent 18FDG PET after routine assessment. Management changes produced by the PET scan and confirmatory tests were reviewed. PET identified unsuspected malignant lesions in 10 (29%) patients. Management changes occurred in 14 (41%), including 6 (18%) patients who were changed to non-surgical therapy. These data suggest that whole-body 18FDG PET improves preoperative assessment of lung cancer patients.

Pre-operative evaluation of lung cancer with CT and MRI

Pre-operative evaluation of lung cancer with CT and MRI

Can a single serum test provide similar or even superior diagnostic information than total body CT, or anti-CEA planar and spect immunoscintigraphy? Value of measuring tissue polypetide antigen (TPA) in the preoperative evaluation of lung cancer

Can a single serum test provide similar or even superior diagnostic information than total body CT, or anti-CEA planar and spect immunoscintigraphy? Value of measuring tissue polypetide antigen (TPA) in the preoperative evaluation of lung cancer

Gallium scanning and tomography in the preoperative evaluation of lung cancer

Gallium scanning and tomography in the preoperative evaluation of lung cancer

Gallium scanning and tomography in the preoperative evaluation of lung cancer.

Discrepant reports on the utility of gallium scanning in the preoperative evaluation of patients with lung cancer prompted a prospective study of the test. The authors studied 47 patients with lung cancer who underwent preoperative gallium scanning and frontal tomography of the mediastinum. Both tests were found to be most accurate in predicting the presence of mediastinal metastases among patients with squamous cell carcinoma. Both test may help direct surgical planning in patients with known squamous cell carcinoma of the lung.