Monday, December 13, 2010
- What is the sensitivity and specificity of a CT scan of the chest for detecting mediastinal involvement in a patient with non-small cell lung cancer?
- What about a PET scan?
|Lung cancer cell dividing. Source: Wellcome Images|
The answers (source):
- CT scan of the chest to diagnose mediastinal disease in NSCLC: Sensitivity 51% and specificity 85%.
- PET scan: Sensitivity 74% and specificity 85%.
In a related editorial, the author points out that the use of this diagnostic modality would be limited to centers where there is expertise in both EUS and EBUS.
I wanted to mention this study briefly to draw attention to the dilemma facing patients with possibly resectable disease. While it's not the most common scenario that the palliative care practitioner faces, occasionally there will be patients with seemingly earlier stage disease who have significant symptoms or psychosocial issues that lead to a palliative care consult. Or perhaps the patient has significant COPD that complicates the situation. I'll hypothesize that the decision of whether to proceed with a thoracotomy in these types of patients is more challenging for both the patient and the health care team. Through having an understanding of the staging dilemmas, a palliative care consultant can work with the oncologist and thoracic surgeon to help guide the patient through the decision.