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Saturday, 23 November 2013

Benign lung tumors - The Diagnosis

Benign lung tumors, growth from many different structures in the lung, is defined as a conditions of abnormal  cell growth with no tendency of spreading or masses that push normal cells out of the way rather than invading surrounding tissue restricted to a limited area in the lung. Approximately one out of 500 chest radiographs shows the incidental finding of a solitary pulmonary nodule and almost one half of these pulmonary lesions are caused by a tumor. Unfortunately, only 2% to 5% of all lung tumors are of benign origin, e. g. lipoma, fibroma, hamartoma, and chondroma, and the majority are malignant neoplasms, most commonly primary lung cancer followed by metastases of extrapulmonary primary carcinomas. According to the study by Universitätsklinik für Pneumologie(a)
C. Diagnosis and tests
Most case of lung tumors are found accidentally in chest X ray.
Solitary pulmonary nodule represents 0.2% of incidental findings in routine chest X-ray images. One of the main diagnoses includes lung cancer in which small-cell subtype has a poor survival rate. Recently, a new classification has been proposed including the very limited disease stage (VLD stage) or T1-T2N0M0 with better survival rate, specifically in those patients who are treated with surgery(15).
The aim of the differentiation is to prevent the spreading of the lung nodules if they have become malignancy
1. Comparison chest X ray and repeat chest X ray
The  lung tumor will be compared with chest X ray taken in last year for the potentail of malidnancy.
If lung nodule found in the X ray is new and can not be compared than Repeat chest X ray if your doctor suspected that nodule is likely benign.

2.  Bronchoscopy
In the study in comparison of transbronchial needle aspiration (TBNA) with cytology brush and forceps biopsy, in the diagnosis of a pulmonary mass or coin lesions has been studied by Shure and Wang in the past, found that the needle brush and TBNA have a higher diagnostic yield in malignant lung masses or nodules. The use of regular brush and forceps biopsy did not increase the diagnostic yield in malignancy. Forceps biopsy might be more useful in benign diseases(15a).
3.  Biopsy, Thoracoscopy and neodymium:yttrium-aluminum garnet laser
Between January 1991 and June 1992, 242 patients with indeterminate solitary lung nodules underwent thoracoscopic excisional biopsy as the primary diagnostic method. Wedge excisions of the nodules were all performed by thoracoscopic techniques using an endoscopic stapler alone (72%), neodymium:yttrium-aluminum garnet laser (18%), or both (10%)(16).

4. CT scan
Proposed is a method for statistical analysis for a small sample size, repeated measure experiment with nesting factors. In the original experiment the Student t-test was used for analysis. Using the same data, we modeled the experiment into two groups of mice with benign and malignant primary lung tumors. 4 tumor nodules were selected from each mouse (N= 36). The dependent variables are the volume, diameter, and signal attenuation measured using computed tomography (CT), according to the study by The University of Texas Health Sciences Center at Houston, Houston(17).

5. Radial EBUS navigation
In the study to examine the sensitivity and factors that may impact the diagnostic yield of a similar technology, namely, radial endobronchial ultrasound (EBUS), found that lesion size, distance, presence of a computerized tomography bronchus sign, or lobar location may not impact the diagnostic yield of bronchoscopic biopsy of peripheral lung nodules with radial EBUS navigation(18).

6. Etc.