Lung Cancer Screening and Diagnosis

Technological advancements in the early detection of lung cancer have improved lung cancer screening significantly. Most recently, a large clinical trial, called the National Lung Screening Trial (NLST), confirmed that screening individuals at high risk for lung cancer with an annual low-dose CT (LDCT) scan of the chest saves lives. The clinical trial, sponsored by the National Cancer Institute (NCI), found that LDCT lung cancer screening can lower the risk of death by 20 percent in high-risk individuals. The U.S. Preventive Services Task Force, National Comprehensive Cancer Network (NCCN), American College of Chest Physicians and American Society of Clinical Oncologists recommend LDCT lung cancer screening for high-risk individuals.

According to the NCCN, high-risk individuals include those ages 55 through 74 with a 30+ pack-year history of smoking; and if not still smoking, you must have quit in the past 15 years.

Currently most private insurers and Medicare reimburse for LDCT lung cancer screening. We offer screening to individuals who meet the established NCCN high-risk criteria after consulting with and obtaining an order from their primary care physician (PCP).

The LDCT scan is a simple, easy and quick test that combines computed tomography (CT) scans with X-rays and computer technology to produce cross-sectional images or slices of the body both horizontally and vertically. LDCT uses up to 40 percent less radiation exposure compared to traditional scanners while still retaining excellent image quality. The exam takes less than 10 seconds and does not require medication or restrictions on eating.

If you or someone in your family meets the high-risk criteria established by the NCCN, our Cancer Institute's specialists recommend that you discuss your risk factors with your primary care provider. In addition, Doylestown Health's oncology nurse navigator can also help you with questions or provide additional information.

At Doylestown Health, we offer the most advanced imaging technology available to detect lung cancer early. Imaging tests take pictures of the inside of your body to help our oncologists, surgeons, pulmonologists and pathologists detect and diagnose lung cancer. These tests also provide important information to your doctor to determine if cancer has spread, if treatment is effective or if cancer has come back after treatment.

If you are at risk for lung cancer or have symptoms of the disease, our lung cancer team may prescribe one or more of these tests:

• Bronchoscopy: A thin, lighted, flexible tube called a bronchoscope is passed through the mouth or nose and into the larger airways of the lungs to help your doctor see tumors. This test is also used to take samples of tissue or fluids to see if cancer cells are present.
• Chest CT scan: Examines abnormalities found on conventional chest x-rays and helps diagnose clinical signs or symptoms such as cough, chest pain or shortness of breath. CT scans may also detect and evaluate tumors in the chest or determine if tumors have spread to other areas. Our team also uses CT scans to assess whether tumors are responding to treatment or to plan for radiation therapy.
• Endobronchial ultrasound (EBUS): For this procedure, a bronchoscope is fitted with an ultrasound device at its tip to take high-resolution pictures inside your body. It is passed down into the windpipe to look at tissue, nearby lymph nodes and other structures in the chest to more accurately determine the presence or stage of lung cancer. During the test, our physicians insert a hollow needle through the bronchoscope that is guided by ultrasound into an area of concern to take biopsy samples of enlarged lymph nodes or suspicious tissue.
• Fine-needle biopsy: A long, thin or fine needle removes a sample of cells from a suspicious area for examination by our pathologists for cancerous cells.
• Mediastinoscopy and mediastinotomy: This mini-incision procedure allows the surgeon to sample lymph nodes near the windpipe and give information about extent or absence of tumor in important areas in the center of the chest. Many times a CT scan or positron emission testing (PET) scan will identify suspicious lymph nodes in this area, especially when there is a lung abnormality under evaluation. Results from this procedure may alter lung tumor treatment.
• PET scan: A PET scan measures important body functions, such as blood flow, oxygen use and glucose metabolism, to evaluate how well organs and tissues are functioning. Cancer cells in the body absorb large amounts of sugar. During a PET scan, a form of radioactive sugar is injected into the blood. A special camera is used to spot the radioactivity or to show whether cancer has spread to the lymph nodes or other parts of the body.
• PET/CT scan: Provides images that pinpoint the anatomic location of abnormal metabolic activity within the body to effectively diagnose, stage, and monitor therapy for different cancers, including lung cancer.
• Robotic-assisted bronchoscopy: Like traditional bronchoscopy, a camera-lit tube is inserted through your mouth or nose to get a picture of the lungs. Robotic-assisted bronchoscopy differs because the tube is smaller and your physician uses a controller to move the small tube in more precise ways. This allows the tube to reach parts of the lung that may have been challenging to access with traditional bronchoscopy techniques. While the physician is controlling the robotic system, a 3-D map of your lung is shown on a computer screen.
• Sputum cytology: Is a mucus sample, also called phlegm, which you cough up from your lungs for further scrutiny under a microscope to see if cancer cells are present.
• Thoracentesis: A test that checks whether fluid around the lungs is caused by cancer or some other medical problem. A needle is placed between the ribs to drain the fluid and check for cancer cells.
• Thoracoscopy: Your doctor makes a small incision and uses a thin, lighted tube connected to a video camera and screen to look at the space between your lungs and the chest wall. The doctor can see small tumors on the lung or lining of the chest wall and extract pieces of tissue to examine under a microscope. Thoracoscopy is also used for treatment to remove part of a lung in some early-stage lung cancers.
• Transthoracic needle aspiration (TTNA): A biopsy generally used in an initial procedure to evaluate if suspicious lesions may be malignant.