Cleveland Clinic journal of medicine
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We are entering a new era in which lung cancer screening may be considered the standard of care. The National Lung Screening Trial (NLST) has shown that the number of deaths due to lung cancer can be reduced through screening with low-dose computed tomography (CT) in a high-risk population (N Engl J Med 2011; 365:395-409). Key issues--such as how to manage lung nodules, how to improve cost-effectiveness, and how to minimize radiation exposure--need to be addressed when designing a lung cancer screening program. Time and further technical advances will help to optimize the programs that are developed.
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The goal of screening is to detect disease at a stage when cure or control is possible, thereby decreasing disease-specific deaths in the population. Many studies have attempted to demonstrate that lung cancer screening using chest radiography or computed tomography (CT) identifies patients with lung cancer and reduces cancer-related mortality. Until recently, there was no evidence confirming a reduction in disease-specific mortality with screening. ⋯ Lead-time, length-time, and overdiagnosis biases may each have an impact on screening studies reporting survival as an outcome. In this past year, the National Lung Screening Trial reported a significant reduction in cancer-related mortality as a result of screening with chest CT imaging. This will shape the direction of future screening programs.
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Review Case Reports
Video-assisted thoracoscopic surgery for the treatment of lung cancer.
A growing proportion of lung resections is being performed by video-assisted thoracoscopic surgery (VATS). VATS lobectomy is indicated for clinical stage I suspected lung cancer with pulmonary function sufficient to tolerate resection. ⋯ A potential oncologic benefit of VATS lobectomy (over thoracotomy) has been proposed through attenuation of postoperative cytokine release. Regardless of whether VATS or an open approach is utilized, thorough lymphadenectomy is important and may confer an additional survival benefit.
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Various techniques, including standard bronchoscopy, transthoracic needle aspiration and mediastinoscopy, are used for diagnosis and staging of lung cancer. Minimizing the number of invasive procedures for lung cancer diagnosis and staging is preferred, however, and a growing number of bronchoscopic techniques are being used. Currently available techniques for the initial diagnosis of lung cancer include electromagnetic navigation bronchoscopy with computed tomography mapping and sample collection, endobronchial ultrasound (EBUS) using radial or convex probe tips, and the combination of the two approaches. ⋯ Several studies have demonstrated the utility of this approach for less invasive lung cancer mediastinal staging. EBUS-TBNA has also been used in the collection of tissue samples for the analysis of tumor biomarkers that significantly influence the selection of cancer treatment strategies. Evidence suggests that EBUS-TBNA may be less useful for restaging patients with lung cancer after cytotoxic therapy.