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The Efficient Workup of Suspected Lung Cancer

The Efficient Workup of Suspected Lung Cancer Abstract The triage process of patients with suspected cancer of the lung is reviewed, paying particular attention to areas of inefficiency and delay. Most patients with suspected lung cancer are inoperable and can be triaged on presentation. The efficient workup involves confirmation of diagnosis and simultaneous determination of stage and operative status. The physician should search for common sites of metastatic spread, with pragmatic use of biopsies and scans. From the outset, the physician should also pay special attention to the patient's functional status, attitude toward possible surgery, and cardiopulmonary status, with the goal of quickly directing each patient to proper therapy. Back to top Article Information Reprint requests to Section of Medical Oncology, ACC-5, Boston City Hospital, 818 Harrison Ave, Boston, MA 02118 (Dr Prout). References 1. Safran C, Desforges J, Tsichlis PN, et al: Decision analysis to evaluate lymphangiography in the management of patients with Hodgkin's disease. N Engl J Med. 1977;296:1088-1092. PubMedGoogle ScholarCrossref 2. Geddes DM: The natural history of lung cancer: A review based on rates of tumor growth. Br J Dis Chest. 1979;73:1-17. PubMedGoogle ScholarCrossref 3. Hyde L, Wolf J, McCracken S, et al: Natural course of inoperable lung cancer. Chest. 1973;64:309-312. PubMedGoogle ScholarCrossref 4. Lanzotti VJ, Thomas DR, Boyle LE, et al: Survival with inoperable lung cancer. Cancer. 1977;39:303-313.Google ScholarCrossref 5. Matthews MJ, Kanhouwa S, Pickren J, et al: Frequency of residual and metastatic tumors in patients undergoing curative surgical resection for lung cancer. Cancer Chemother Rep. 1973;4:63-67. PubMedGoogle Scholar 6. Line DH, Deeley TJ: The necropsy findings in carcinoma of the bronchus. Br J Dis Chest. 1971;65:238-242. PubMedGoogle ScholarCrossref 7. Brantigan JW, Brantigan CO, Brantigan OC: Biopsy of nonpalpable scalene lymph nodes in carcinoma of the lung. Am Rev Respir Dis. 1973;107:962-974. PubMedGoogle Scholar 8. Skinner DB: Scalene lymph node biopsy. N Engl J Med. 1963;268:1324-1329.Google ScholarCrossref 9. Brosseau JD, Reinecke M, Banerjee TK, et al: The continuing importance of scalene node biopsy in lung cancer patients. Wis Med J. 1976;76:97-99. PubMedGoogle Scholar 10. Salyer WR, Elleston JC, Erozan YS: Efficacy of pleural needle biopsy and pleural fluid cytopathology in the diagnosis of malignant neoplasm involving the pleura. Chest. 1975;67:536-539. PubMedGoogle ScholarCrossref 11. Decker DA, Dines DE, Payne WS, et al: The significance of a cytologically negative pleural effusion in bronchogenic carcinoma. Chest. 1978;74:640-642. PubMedGoogle ScholarCrossref 12. Guttierrez AC, Vincent RG, Bakshi S, et al: Radioisotope scans in the evaluation of metastatic bronchogenic carcinoma. J Thorac Cardiovasc Surg. 1975;69:934-941. PubMedGoogle ScholarCrossref 13. Ramsdell JW, Peters RM, Taylor AT, et al: Multiorgan scans for staging lung cancer. J Thorac Cardiovasc Surg. 1977;73:653-659. PubMedGoogle ScholarCrossref 14. Hooper RG, Beechler CR, Johnson MC: Radioisotope scanning in initial staging of bronchogenic carcinoma. Am Rev Respir Dis. 1978;118:279-286. PubMedGoogle Scholar 15. Muggia F, Schereu LR: Lung cancer: Diagnosis in metastatic sites. Semin Oncol. 1974;1:217-228. PubMedGoogle Scholar 16. Johnson PM, Sweeney WA: The false positive hepatic scan. J Nucl Med. 1967;8:451-460.Google Scholar 17. Castagna J, Benfield JR, Yamada H, et al: The reliability of liver scans and function tests in detecting metastases. Surg Gynecol Obstet. 1972;134:463-466. PubMedGoogle Scholar 18. Margolis R, Hansen HH, Muggia FM, et al: Diagnosis of liver metastases in bronchogenic carcinoma: A comparative study of liver scans, function tests and peritoneoscopy with liver biopsy in 111 patients. Cancer. 1974;34:1825-1829. PubMedGoogle ScholarCrossref 19. Conn HO, Yesner R: A re-evaluation of needle biopsy in the diagnosis of metastatic cancer of the liver. Ann Intern Med. 1963;59:53-61. PubMedGoogle ScholarCrossref 20. Dombernowsky P, Hirsch F, Hansen H, et al: Peritoneoscopy in the staging of 190 patients with small cell anaplastic cancer of the lung. Cancer. 1978;41:2008-2012. PubMedGoogle ScholarCrossref 21. Bell JW: Abdominal exploration in 100 lung cancer suspects prior to thoracotomy. Ann Surg. 1968;167:199-203.Google ScholarCrossref 22. Donato AT, Ammerman EG, Sullesta O: Bone scanning in the evaluation of patients with lung cancer. Ann Thorac Surg. 1979;27:300-304. PubMedGoogle ScholarCrossref 23. Hansen HH, Muggia FM, Selawry OS: Bone marrow examination in 100 consecutive patients with bronchogenic carcinoma. Lancet. 1971;2:443-445. PubMedGoogle ScholarCrossref 24. Guttierrez AC: Evaluation of sternal bone marrow aspiration for detection of tumor cells in patients with bronchogenic carcinoma. J Thorac Cardiovasc Surg. 1979;77:392-395. PubMedGoogle ScholarCrossref 25. DeSantos LA, Goldstein HM: Ultrasonography in tumors arising from the spine and bony pelvis. AJR. 1977;129:1061-1064. PubMedGoogle ScholarCrossref 26. Schajowicz F, Derqui FC: Puncture biopsy in lesions of the locomotor system: Review of results in 4,050 cases, including 941 vertebral punctures. Cancer. 1968;21:531-548.Google ScholarCrossref 27. Butler AR, Leo JS, Lin JP, et al: The value of routine cranial computed tomography in neurologically intact patients with primary carcinoma of the lung. Radiology. 1979;131:399-401. PubMedGoogle ScholarCrossref 28. Posner JB: Management of central nervous system metastases. Semin Oncol. 1977;4:81-91.Google Scholar 29. Davies DF: A review of detection methods for the early diagnosis of lung cancer. J Chronic Dis. 1966;19:819-845. PubMedGoogle ScholarCrossref 30. Kvale B, Bode LR, Kini S: Diagnostic accuracy of lung cancer: Comparison of techniques used in association with flexible fiberoptic bronchoscopy. Chest. 1976;69:752-757. PubMedGoogle ScholarCrossref 31. Chaudhary B, Yoneda K, Burki NK: Fiberoptic bronchoscopy: Comparison of procedures used in diagnosis of lung cancer. J Thorac Cardiovasc Surg. 1978;76:33-37. PubMedGoogle ScholarCrossref 32. Sagel SS, Ferguson TB, Forrest JV, et al: Percutaneous transthoracic aspiration needle biopsy. Ann Thorac Surg. 1978;26:399-405.Google ScholarCrossref 33. Lawhorne T, Baker RR, Carter D: Adenocarcinoma of the lung presenting as a solitary pulmonary nodule. Johns Hopkins Med J. 1973;133:82-87. PubMedGoogle Scholar 34. Senior RM, Adamson JS: Survival in patients with lung cancer. Arch Intern Med. 1970;125:975-980.Google ScholarCrossref 35. Carbone P, Frost JK, Feinstein AR, et al: Lung cancer: Perspectives and prospects. Ann Intern Med. 1970;73:1003-1024.Google ScholarCrossref 36. Feinstein AR: A new staging system for cancer and reappraisal of early treatment and cure by radical surgery. N Engl J Med. 1967;279:747-753.Google ScholarCrossref 37. Tisi GM: Preoperative evaluation of pulmonary function. Am Rev Respir Dis. 1979;119:293-310.Google Scholar 38. Olsen GN, Block AJ, Swenson EW: Pulmonary function evaluation of the lung resection candidate: A prospective study. Am Rev Respir Dis. 1975;111:379-387. PubMedGoogle Scholar 39. Harman E, Lillington G: Pulmonary risk factors in surgery. Med Clin North Am. 1979;63:1289-1298.Google ScholarCrossref 40. Goldman L, Caldera DL, Southwick FS, et al: Cardiac risk factors and complications in noncardiac surgery. Medicine. 1978;57:357-370.Google ScholarCrossref 41. McNeil BJ, Weichselbaum R, Pauker S: Fallacy of the five year survival in lung cancer. N Engl J Med. 1978;299:1396-1401. PubMedGoogle ScholarCrossref 42. Whitcomb ME, Barham E, Goldman EL, et al: Indications for mediastinoscopy in bronchogenic carcinoma. Am Rev Respir Dis. 1976;113:189-195.Google Scholar 43. Acosta JL, Manfredi F: Selective mediastinoscopy. Chest. 1977;71:150-154. PubMedGoogle ScholarCrossref 44. Sealy WC: Mediastinoscopy: Does it have a place in the management of carcinoma of the lung? Ann Thorac Surg. 1974;18:433-436. PubMedGoogle ScholarCrossref 45. Naruke T, Suemasu K, Ishikawa S: Lymph node mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg. 1978;76:832-839. PubMedGoogle ScholarCrossref 46. Rubinstein I, Baum GL, Kalter Y, et al: The influence of cell type and lymph node metastases on survival of patients with carcinoma of the lung undergoing thoracotomy. Am Rev Respir Dis. 1979;119:253-262. PubMedGoogle Scholar 47. Ting Y, Church WR, Ravikrishnan KP: Lung carcinoma superimposed on pulmonary tuberculosis. Radiology. 1976;119:307-312. PubMedGoogle ScholarCrossref 48. Taylor WF: Screening for early lung cancer. Read before the American Cancer Society , National Conference Cancer Prevention and Detection, Chicago, April17 , 1980. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

The Efficient Workup of Suspected Lung Cancer

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340180124023
Publisher site
See Article on Publisher Site

Abstract

Abstract The triage process of patients with suspected cancer of the lung is reviewed, paying particular attention to areas of inefficiency and delay. Most patients with suspected lung cancer are inoperable and can be triaged on presentation. The efficient workup involves confirmation of diagnosis and simultaneous determination of stage and operative status. The physician should search for common sites of metastatic spread, with pragmatic use of biopsies and scans. From the outset, the physician should also pay special attention to the patient's functional status, attitude toward possible surgery, and cardiopulmonary status, with the goal of quickly directing each patient to proper therapy. Back to top Article Information Reprint requests to Section of Medical Oncology, ACC-5, Boston City Hospital, 818 Harrison Ave, Boston, MA 02118 (Dr Prout). References 1. Safran C, Desforges J, Tsichlis PN, et al: Decision analysis to evaluate lymphangiography in the management of patients with Hodgkin's disease. N Engl J Med. 1977;296:1088-1092. PubMedGoogle ScholarCrossref 2. Geddes DM: The natural history of lung cancer: A review based on rates of tumor growth. Br J Dis Chest. 1979;73:1-17. PubMedGoogle ScholarCrossref 3. Hyde L, Wolf J, McCracken S, et al: Natural course of inoperable lung cancer. Chest. 1973;64:309-312. PubMedGoogle ScholarCrossref 4. Lanzotti VJ, Thomas DR, Boyle LE, et al: Survival with inoperable lung cancer. Cancer. 1977;39:303-313.Google ScholarCrossref 5. Matthews MJ, Kanhouwa S, Pickren J, et al: Frequency of residual and metastatic tumors in patients undergoing curative surgical resection for lung cancer. Cancer Chemother Rep. 1973;4:63-67. PubMedGoogle Scholar 6. Line DH, Deeley TJ: The necropsy findings in carcinoma of the bronchus. Br J Dis Chest. 1971;65:238-242. PubMedGoogle ScholarCrossref 7. Brantigan JW, Brantigan CO, Brantigan OC: Biopsy of nonpalpable scalene lymph nodes in carcinoma of the lung. Am Rev Respir Dis. 1973;107:962-974. PubMedGoogle Scholar 8. Skinner DB: Scalene lymph node biopsy. N Engl J Med. 1963;268:1324-1329.Google ScholarCrossref 9. Brosseau JD, Reinecke M, Banerjee TK, et al: The continuing importance of scalene node biopsy in lung cancer patients. Wis Med J. 1976;76:97-99. PubMedGoogle Scholar 10. Salyer WR, Elleston JC, Erozan YS: Efficacy of pleural needle biopsy and pleural fluid cytopathology in the diagnosis of malignant neoplasm involving the pleura. Chest. 1975;67:536-539. PubMedGoogle ScholarCrossref 11. Decker DA, Dines DE, Payne WS, et al: The significance of a cytologically negative pleural effusion in bronchogenic carcinoma. Chest. 1978;74:640-642. PubMedGoogle ScholarCrossref 12. Guttierrez AC, Vincent RG, Bakshi S, et al: Radioisotope scans in the evaluation of metastatic bronchogenic carcinoma. J Thorac Cardiovasc Surg. 1975;69:934-941. PubMedGoogle ScholarCrossref 13. Ramsdell JW, Peters RM, Taylor AT, et al: Multiorgan scans for staging lung cancer. J Thorac Cardiovasc Surg. 1977;73:653-659. PubMedGoogle ScholarCrossref 14. Hooper RG, Beechler CR, Johnson MC: Radioisotope scanning in initial staging of bronchogenic carcinoma. Am Rev Respir Dis. 1978;118:279-286. PubMedGoogle Scholar 15. Muggia F, Schereu LR: Lung cancer: Diagnosis in metastatic sites. Semin Oncol. 1974;1:217-228. PubMedGoogle Scholar 16. Johnson PM, Sweeney WA: The false positive hepatic scan. J Nucl Med. 1967;8:451-460.Google Scholar 17. Castagna J, Benfield JR, Yamada H, et al: The reliability of liver scans and function tests in detecting metastases. Surg Gynecol Obstet. 1972;134:463-466. PubMedGoogle Scholar 18. Margolis R, Hansen HH, Muggia FM, et al: Diagnosis of liver metastases in bronchogenic carcinoma: A comparative study of liver scans, function tests and peritoneoscopy with liver biopsy in 111 patients. Cancer. 1974;34:1825-1829. PubMedGoogle ScholarCrossref 19. Conn HO, Yesner R: A re-evaluation of needle biopsy in the diagnosis of metastatic cancer of the liver. Ann Intern Med. 1963;59:53-61. PubMedGoogle ScholarCrossref 20. Dombernowsky P, Hirsch F, Hansen H, et al: Peritoneoscopy in the staging of 190 patients with small cell anaplastic cancer of the lung. Cancer. 1978;41:2008-2012. PubMedGoogle ScholarCrossref 21. Bell JW: Abdominal exploration in 100 lung cancer suspects prior to thoracotomy. Ann Surg. 1968;167:199-203.Google ScholarCrossref 22. Donato AT, Ammerman EG, Sullesta O: Bone scanning in the evaluation of patients with lung cancer. Ann Thorac Surg. 1979;27:300-304. PubMedGoogle ScholarCrossref 23. Hansen HH, Muggia FM, Selawry OS: Bone marrow examination in 100 consecutive patients with bronchogenic carcinoma. Lancet. 1971;2:443-445. PubMedGoogle ScholarCrossref 24. Guttierrez AC: Evaluation of sternal bone marrow aspiration for detection of tumor cells in patients with bronchogenic carcinoma. J Thorac Cardiovasc Surg. 1979;77:392-395. PubMedGoogle ScholarCrossref 25. DeSantos LA, Goldstein HM: Ultrasonography in tumors arising from the spine and bony pelvis. AJR. 1977;129:1061-1064. PubMedGoogle ScholarCrossref 26. Schajowicz F, Derqui FC: Puncture biopsy in lesions of the locomotor system: Review of results in 4,050 cases, including 941 vertebral punctures. Cancer. 1968;21:531-548.Google ScholarCrossref 27. Butler AR, Leo JS, Lin JP, et al: The value of routine cranial computed tomography in neurologically intact patients with primary carcinoma of the lung. Radiology. 1979;131:399-401. PubMedGoogle ScholarCrossref 28. Posner JB: Management of central nervous system metastases. Semin Oncol. 1977;4:81-91.Google Scholar 29. Davies DF: A review of detection methods for the early diagnosis of lung cancer. J Chronic Dis. 1966;19:819-845. PubMedGoogle ScholarCrossref 30. Kvale B, Bode LR, Kini S: Diagnostic accuracy of lung cancer: Comparison of techniques used in association with flexible fiberoptic bronchoscopy. Chest. 1976;69:752-757. PubMedGoogle ScholarCrossref 31. Chaudhary B, Yoneda K, Burki NK: Fiberoptic bronchoscopy: Comparison of procedures used in diagnosis of lung cancer. J Thorac Cardiovasc Surg. 1978;76:33-37. PubMedGoogle ScholarCrossref 32. Sagel SS, Ferguson TB, Forrest JV, et al: Percutaneous transthoracic aspiration needle biopsy. Ann Thorac Surg. 1978;26:399-405.Google ScholarCrossref 33. Lawhorne T, Baker RR, Carter D: Adenocarcinoma of the lung presenting as a solitary pulmonary nodule. Johns Hopkins Med J. 1973;133:82-87. PubMedGoogle Scholar 34. Senior RM, Adamson JS: Survival in patients with lung cancer. Arch Intern Med. 1970;125:975-980.Google ScholarCrossref 35. Carbone P, Frost JK, Feinstein AR, et al: Lung cancer: Perspectives and prospects. Ann Intern Med. 1970;73:1003-1024.Google ScholarCrossref 36. Feinstein AR: A new staging system for cancer and reappraisal of early treatment and cure by radical surgery. N Engl J Med. 1967;279:747-753.Google ScholarCrossref 37. Tisi GM: Preoperative evaluation of pulmonary function. Am Rev Respir Dis. 1979;119:293-310.Google Scholar 38. Olsen GN, Block AJ, Swenson EW: Pulmonary function evaluation of the lung resection candidate: A prospective study. Am Rev Respir Dis. 1975;111:379-387. PubMedGoogle Scholar 39. Harman E, Lillington G: Pulmonary risk factors in surgery. Med Clin North Am. 1979;63:1289-1298.Google ScholarCrossref 40. Goldman L, Caldera DL, Southwick FS, et al: Cardiac risk factors and complications in noncardiac surgery. Medicine. 1978;57:357-370.Google ScholarCrossref 41. McNeil BJ, Weichselbaum R, Pauker S: Fallacy of the five year survival in lung cancer. N Engl J Med. 1978;299:1396-1401. PubMedGoogle ScholarCrossref 42. Whitcomb ME, Barham E, Goldman EL, et al: Indications for mediastinoscopy in bronchogenic carcinoma. Am Rev Respir Dis. 1976;113:189-195.Google Scholar 43. Acosta JL, Manfredi F: Selective mediastinoscopy. Chest. 1977;71:150-154. PubMedGoogle ScholarCrossref 44. Sealy WC: Mediastinoscopy: Does it have a place in the management of carcinoma of the lung? Ann Thorac Surg. 1974;18:433-436. PubMedGoogle ScholarCrossref 45. Naruke T, Suemasu K, Ishikawa S: Lymph node mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg. 1978;76:832-839. PubMedGoogle ScholarCrossref 46. Rubinstein I, Baum GL, Kalter Y, et al: The influence of cell type and lymph node metastases on survival of patients with carcinoma of the lung undergoing thoracotomy. Am Rev Respir Dis. 1979;119:253-262. PubMedGoogle Scholar 47. Ting Y, Church WR, Ravikrishnan KP: Lung carcinoma superimposed on pulmonary tuberculosis. Radiology. 1976;119:307-312. PubMedGoogle ScholarCrossref 48. Taylor WF: Screening for early lung cancer. Read before the American Cancer Society , National Conference Cancer Prevention and Detection, Chicago, April17 , 1980.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 1, 1982

Keywords: lung cancer,functional status,biopsy,surgical procedures, operative,triage

References