Researchers find less invasive, highly accura...(n be treated with potentially curative s...),Health

Date:2/5/2008

n be treated with potentially curative surgery to remove lung tumors, and chemotherapy and radiation are used for patients whose cancer has spread. Staging of cancer is the process by which doctors determine whether a cancer has spread to other sites such as lymph nodes or other organs, and thus which is the most appropriate treatment.

Shortcomings in each method of staging

The traditional staging technique is to first perform a CAT scan of the lungs to find enlarged lymph nodes. PET scans are also used to determine if a cancer has spread, but both CT and PET have limits, Dr. Wallace says. They can only determine if a lymph node is enlarged or has a high metabolism; features which suggest, but do not prove that cancer is present. Most doctors, including the American College of Chest Physicians, now recommend that CT and PET scans be confirmed with a biopsy of the lymph nodes.

Traditionally, such a biopsy could only be done surgically by inserting a rigid steel scope into the chest through a surgical opening above the breast bone. The scope is maneuvered to lymph nodes of interest and a small piece of tissue is taken to look for signs of cancer. This procedure, known as a mediastinoscopy, can only access lymph nodes on the front or sides of the lungs, Dr. Wallace says. Studies summarized by the American College of Chest Physicians have shown it is approximately 78 percent sensitive that is, of all patients whose lung cancer has spread to lymph nodes, this technique can pick up, at most, 78 percent of them, he says. Another limitation of mediastinoscopy is the need for general anesthesia, and the small but real risk of major complications, Dr. Wallace says.

Most lung cancer staging still is done today by mediastinoscopy, but several less-invasive techniques are also now being used. The most common is transbronchial needle aspiration (TBNA), in which a physician places a bronchoscope into the trachea and based on a CT scan,
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Contact: Paul Scotti scotti.paul@mayo.edu 904-953-2299 Mayo Clinic Source:Eurekalert

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