Lung Cancer (Bronchial Carcinoma): Diagnostic Tests

Mandatory medical device diagnostics.

  • X-ray of the thorax (chest x-ray/chest x-ray), in two planes – an unremarkable x-ray does not exclude the presence of bronchial carcinoma! [any pulmonary nodule is potentially malignant/malignant until proven otherwise].
  • Computed tomography of the thorax / chest (thoracic CT) with contrast administration – as a basic diagnostic with a tumor detection from a size of about 1.5 cmIndication! Round nodules in the lung that appear as non-solid nodules on low-dose computed tomography (CT) do not require immediate biopsy or surgical removal.
  • Computed tomography (CT) of the abdomen (abdominal CT) – to exclude primarily liver metastases; basic diagnostic tool in preoperative staging.
  • Computed tomography of the skull (cranial CT, cranial CT or cCT) or magnetic resonance imaging of the skull (cranial MRI, cranial MRI or cMRI) – to exclude brain metastases; basic diagnostic in preoperative staging when metastases are suspected.
  • Skeletal scintigraphy (nuclear medicine procedure that can represent functional changes in the skeletal system, in which regionally (locally) pathologically (pathologically) increased or decreased bone remodeling processes are present) – to exclude bone metastases; basic diagnostic in preoperative staging.
  • Bronchoscopy (lung endoscopy) with biopsy (tissue sampling); only if therapeutically relevant.
  • 18F-flurodeoxyglucose (FDG-)-positron emission tomography (PET)-CT
    • In clinical stage IB-IIIB with curative treatment intent to determine whether mediastinal lymph nodes are altered or enlarged and whether there is evidence of distant metastasis/settlement of tumor cells from the site of origin via the blood/lymphatic system to a distant site in the body and growth of new tumor tissue there (M0 status)
    • FDG-PET: To clarify the dignity (biological behavior of tumors; i.e., whether they are benign (benign) or malignant (malignant)) of lung lesions [sensitivity (percentage of diseased patients in whom the disease is detected by use of the procedure, i.e. a positive finding occurs) 89%, specificity (probability that actually healthy people who do not have the disease in question are also detected as healthy by the procedure) 75%; frequent misdiagnosis by fungal diseases of the lung: histoplasmosis, coccidioidomycosis or blastomycosis].

Depending on tumor type and stage, further diagnostic measures may be indicated:

  • Positron emission tomography (PET; nuclear medicine procedure that allows the creation of cross-sectional images of living organisms by visualizing the distribution patterns of weak radioactive substances) or PET-CT – to detect metastases in non-small cell bronchial carcinoma.
  • Thoracoscopy (reflection of the thoracic cavity) – endoscopic examination of the pleural cavity for evaluation for planned surgery.
  • Mediastinoscopy (mirroring of the middle space located between both lungs) [Endosonography (endoscopic ultrasound (EUS); ultrasound examination performed from the inside, i.e., the ultrasound probe is brought into direct contact with the internal surface (for example, the mucosa of the stomach/intestine) by means of an endoscope (optical instrument)) is more sensitive than mediastinoscopy]
    • Endoscopic examination of the mediastinum.
    • To classify the stages of tumor disease and to exclude metastases (daughter tumors) of the lymph nodes.
  • Abdominal sonography (ultrasound examination of the abdominal organs) – for basic diagnostics.
  • Transthoracic (through the chest) fine needle biopsy (tissue sampling) – for peripheral tumor.
  • Pleural puncture (needle advanced through skin, fat, and muscle to pleural space) – for pleural effusion; diagnostic and therapeutic
  • Bone marrow aspiration – for pathologic blood counts, small cell lung cancer or advanced non-small cell lung cancer.
  • Pulmonary function testing (LuFu) and arterial blood gas analysis (ABG) – for signs of respiratory insufficiency (respiratory weakness).
  • X-ray contrast maw swallow – when esophageal involvement (involvement of the esophagus) is suspected.

Lung cancer screening

  • Low-dose CT (Engl.Low-dose CT, LDCT): The National Lung Screening Trial (NLST) demonstrated a 20% reduction in lung cancer mortality (death rate) in older and heavy smokers with LDCT. According to the S3 guideline: for defined risk populations a may recommendation with recommendation grade 0 (option).
  • Subjects with noncalcified nodules (NCN) detected by CT lung cancer screening had a significantly increased risk of lung cancer compared with subjects without NCN: in the first 4 years, the risk was increased fivefold, and even 12 years later, the risk of disease was more than twice as high.