EUS-FNA (carinal lymph nodes), eventually in combination with CT or FDG-PET and EBUS-TBNA (right mediastinal lymph nodes), superior to TBNA alone, are novel imaging techniques with a high accuracy. MRI is more suitable for this purpose, but is limited available. PET-CT is the most important imaging tool for lung cancer analysis and better than CT or FDG-PET alone, but not optimal for determination of tumour invasion in mediastinal or other adjacent structures.
Shortening and intensifying the diagnostic track by combining diagnostic and staging procedures would preclude unnecessary tests and procedures, lowering the total hospital costs per patient and may lead to more satisfaction for patient and physician. Important reasons for physicians to shorten diagnostic tumor analysis. Hospital visits as a consequence of this are a financial burden. Long waiting times with uncertainty about the outcome are a waste of time and unacceptable for the patient. Patients have to pass different diagnostic phases in their analysis of a chest X-ray suspicious for lung cancer. Procedure: fast track diagnosis Procedure: conventional diagnosis These figures will be compared with the historical study group. The timelines from initial chest X-ray to diagnostic day to informing the patient to start of treatment will be determined. This historical study group is chosen from an era before the availability of integrated PET-CT and ultrasound guided endoscopic tools and meets the same inclusion and exclusion criteria as the patients in this study. The number of tests and diagnostic procedures needed to obtain a diagnosis, including tumor stage (especially final stage NSCLC) and function tests, will be compared with a historical matched study group. The percentage of patients in which this diagnostic track leads to a diagnosis and tumor stage in one day will be determined. Mediastinal staging will be done with bronchoscopy alone for central located tumors, peripherally located lesions will be analysed with EUS-FNA or bronchoscopy. Mediastinal and adjacent structures will be analysed with EUS-FNA. Depending on the location of lesions seen on PET-CT, further invasive diagnostic procedures will be planned for the afternoon. All patients will get PET-CT scanning in the morning of the study day. Patients will be admitted at the pulmonary ward for the study day and will be accompanied by nurses. Hundred patients will be recruited by means of informed consent. Waiting time to enter the study will be no longer than one week. Informed consent forms, patient information forms and a time table for the diagnostic day are provided by mail or E-mail in cases where time gets short. The questionnaire screens patients' interest, co-morbidity and medication use. Selected patients are invited to enter the study after answering a questionnaire by phone (p. The X-ray and referral are studied by a chest physician (by phone or fax ). Patients who are admitted to the outpatient pulmonology department by a general practitioner or specialist with a chest X-ray suspicious for lung cancer with an age between 18 and 80 years are suitable for participation. Why Should I Register and Submit Results?.WE ARE CERTIFIED BY THE STATE COUNCIL OF HIGHER EDUCATION FOR VIRGINIA (SCHEV).
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