Diagnosis, staging and functional operability of lung cancerDiagnose, Staging und funktionelle Operabilität bei Lungenkarzinom

BACKGROUND: Especially advanced stages of non-small cell lung cancer are often considered a diagnostic and staging dilemma. METHODS: Review of recent literature. RESULTS: Today the operability of lung cancer is decreasingly determined by technical aspects related to the primary tumour (resectability), but rather by oncological considerations (operability). Histological verification is usually achieved endoscopically in centrally located tumours and by CT-guided needle biopsy in periphereal lesions. Modern spiral CT enables very reliable judgement to be made concerning malignant infiltration of surrounding anatomical structures and enlarged mediastinal lymph nodes stations. However, the predictive value of CT in evaluating mediastinal lymph node is still limited. Positron emission tomography (PET) has a negative predictive value in this respect of 91–99%, whereas the positive predictive value is presently not more than 40–60%. Hence, further surgical verification through mediastinoscopy is necessary in the latter cases. Diagnostic approaches to proper staging of the T, N and M aspects of the disease as well as estimation of functional operability through preoperative pulmonary function analysis are discussed in detail. CONCLUSIONS: Proper diagnostic algorithms at evidence of lung cancer are of crucial importance because any therapeutical measures and prognoses strongly depend on the clinical stage.