cancer lungs: 10 DIAGNOSTIC PROCEDURES

A. Photo chest roentgens in Posterior-anterior (PA) and lateral

Simple initial examinations that can detect lung cancer. Mayo Clinic Study of the USA, found 61 % of lung tumors were detected in routine examination with normal chest roentgens images, whereas sputum cytologic examination can detect only 19 % . In lung cancer, breast examination roentgens photo also necessary to re-evaluate its doubling time. Reported that most lung cancer has a doubling time of 37 - 465 days. When the doubling time> 18 months, mean tumor benign. The signs of other tumors are benign lesions, concentric spherical, solid and calcification of the firm.

Inspection photos chest roentgens tomography more accurate ways to support the possibility of lung tumors, when the usual way breast images can not confirm the presence of tumors. Investigations another radiologist who sometimes is also necessary bronkografi, fluoroscopy, superior vena cavografi, ventilation / perfusion scanning, ultrasound sonography.

In photos roentgens primary lung cancer can be seen as a solitary round shadow or cause the collapse of a lobe due to bronchial tumor block. Early cancer can be very small and irregular shape, but usually will be fine when growing up. While the picture radiologist for secondary lung tumors does not indicate where the location of the primary tumor.

B. Examination Computed Tomography and Magnetic Resonance Imaging

CT scan at thorax, more sensitive than normal chest image examination, because it can detect abnormalities or nodules with a minimum diameter of 3 mm, although false positives for abnormalities of this magnitude can reach 25 - 60 %. If this facility possible, a CT scan could be a second screening examination after normal chest images. Magnetic Resonance Imaging examination (MRI) is not routinely done, because he is limited to assessing the invading tumor abnormalities in the vertebrae, spinal medulla, the mediastinum, in addition to cost is also quite expensive.

MR examination thorax not superior to CT scan thorax. We are developing a technique that is more accurate imaging of Positron Emission Tomography (PET) can distinguish benign and malignant tumors based on differences in metabolism of biochemical substances case of glucose, oxygen, proteins, nucleic acids. Examples of substances used methionine 11 C and F - 18 fluorodeoxyglucose (FD6).

Tumors less than 1 cm, somewhat difficult to detect because of the small size is less resolusion by PET Scanner. Sensitivity and specificity reported how PET is 83-93% 60-90% sensitive and specific.

Some false positives to be found also a sign of malignant lesions such as inflammation and infection and tuberculosis aspergilosis. Although it is known from several studies PET examination has better accuracy values than CT scans.

C. Inspection of Bone Scanning

This examination is required if the expected signs of metastases to the bone. Tumor incidence of non small cell lung cancer (NSCLC) to bone was reported by 15 %.

D. Sputum cytology examination

Sputum cytology examination is done routinely, especially when patients have complaints such as cough. Cytologic examination does not always give positive results because it depends on:
 Location of tumors of the bronchus
 Type of tumor
 Engineering issued a sputum
 The number of sputum examination. Examination is recommended 3 - 5 days in a row
 When sputum examination (sputum must be fresh)

In lung cancer, which is central to good sputum examination can give positive results up to 67 - 85 % in squamous cell carcinoma. Sputum cytology examination is recommended as a routine examination and screening for early diagnosis of lung cancer, and they are developing early diagnosis using sputum examination staining with immune MAB with antigen antibody 624 H 12 for SCLC (small cell lung cancer) and 703 D4 antibodies to antigens NSCLC (non small cell lung carcinoma). Reports from the National Cancer Institute USA this technique gives results 91 %, 88 % sensitive and specific.

Other cytologic examination for lung cancer diagnostics can be performed on pleural fluid, aspiration of cervical lymph nodes, supraklavikula, rinse and bronchus on bronchoscopy sweep.

E. Histopathology examination

Histopathologic examination is the gold standard for diagnosis of lung cancer to obtain biopsy specimens in a way through:

Bronchoscopy. Modification of fiber-optic bronchoscopy may include:
 Trans bronchial lung biopsy (TBLB) with the demands of fluoroscopy or ultrasound.
 Recently fuorescence examination was developed by using fluorescence bronchoscopy exchanging agent such as Hp D (hemato porphyrin derivate) gave fluorescence concentrates in cancer tissue. The newer technique is to auto fluorescence bronchoscopy. The results of this examination showed 50% more sensitive than white light bronchoscopy for detection of carcinoma in situ and severe dysplasia.
 Ultrasound bronchoscopy, also developed at this time to detect peripheral tumors, endobronkial tumors, lymph node lesions of the mediastinum and hilar regions.
 positive result with bronchoscopy can be reached: 95 % for centrally located tumors and 70-80% for tumors of peripheral location.
 Trans-bronchial-Needle Aspiration (TBNA). Working against lymph nodules in the hilar or mediastinal. The result will be better when guided by CT scan.

How to examination by bronchoscopy is to insert a tube pipe flexible bronchoscope into the airways. In this way doctors can look inside the lungs and lung tissue samples taken for laboratory examination.


Trans Torakal biopsy (TTB)
If the patient has cavities fluid in the lungs, the doctor may take a sample by inserting a thin needle into the chest between the ribs. Fluid is then examined in the laboratory, to see whether or not cancer cells. Raised a number of liquids with a biopsy or torasentesis can also improve breathing.

Biopsy with TTB especially for lesions located peripheral to the size of < 2 cm sensitivity reached 90 - 95 %. Complications pneumothorak can reach 20 - 25 % and haemoptysis up to 20 %. With better preparation, these complications can be minimized. Examination results will be better if there is demand for CT scans, ultrasound, or fluoroscopy. Biopsy of lymph nodes palpable, can be done in Daniel's biopsy of the lymph-nodes scalaneus supraklavikular. Torakoskopi. Biopsy of the tumor in the pleura give better results than by way torakoskopi blind (blind). For tumors located on the surface of the pleural biopsy with the way visceralis Video Assisted Thoracoscopy has a sensitivity and specificity to 100 %, whereas complications occur is very small. Mediatinoskopi. More than 20 % of lung cancers metastasize to the mediastinum, especially Small Cell and Large Cell Ca Ca. to obtain tumor metastases or lymph nodes involved can be done by mediastinoskopi where mediastinoskopi inserted through the supra-sternal incision. This can help assess how far the cancer has spread and whether the operation is wise choice to remove the tumor. Biopsy results positive value 40 %. From other studies on the false negative values obtained mediastinoskopi of 8 - 12 (followed by Thoracotomy).

Thoracotomy for lung cancer diagnostic procedures done when non-invasive and invasive previously failed to find tumor cells.