Application of an Algorithm for Staging Small-cell Lung Cancer Can Save One Third of the Initial Evaluation Costs

Richardson, Gary; Venzon, David; Edison, Margaret; Brown, M L; Frame, James N.; Ihde, Daniel C.; Johnson, Bruce E.

doi:10.1001/archinte.1993.00410030043007

Cited by 23 publications

(5 citation statements)

References 55 publications

(1 reference statement)

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“…For example, in small cell carcinoma of the lung it has been concluded that bone marrow examination is not necessary 12 or is rarely necessary. 13 The bone marrow is the sole site of detected metastatic disease in less than 2% of patients and those with bone marrow infiltration have a median survival only a little worse than that of other patients with extensive disease. 12 It has been estimated that if an appropriate algorithm is followed and investigation is stopped as soon as the first site of metastatic disease is identified unnecessary investigation can be avoided and a third of initial evaluation costs can be saved.…”

Section: Metastatic Tumourmentioning

confidence: 99%

“…12 It has been estimated that if an appropriate algorithm is followed and investigation is stopped as soon as the first site of metastatic disease is identified unnecessary investigation can be avoided and a third of initial evaluation costs can be saved. 13 Bone marrow trephine biopsy is essential in the initial staging of certain paediatric tumours, such as neuroblastoma, rhabdomyosarcoma, primitive neuroectodermal tumour, and Ewing's tumour. The detection of bone marrow infiltration in the initial staging bone marrow biopsy means that trephine biopsy is also required during follow up.…”

Section: Metastatic Tumourmentioning

confidence: 99%

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Bone marrow trephine biopsy

Bain¹

2001

Journal of Clinical Pathology

192

151

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Trephine biopsies of the bone marrow should be carried out, when clinically indicated, by trained individuals following a standard operating procedure. A bone marrow aspiration should be performed as part of the same procedure. For patient safety and convenience, biopsies are usually performed on the posterior iliac crest. The biopsy specimen should measure at least 1.6 cm and, if it does not, consideration should be given to repeating the procedure, possibly on the contralateral iliac crest. If bone marrow aspiration is found to be impossible, imprints from the biopsy specimen should be obtained. Otherwise, the specimen is placed immediately into fixative and after fixation is embedded in a resin or, more usually, decalcified and embedded in paraYn wax. Thin sections are cut and are stained, as a minimum, with haematoxylin and eosin and with a reticulin stain. A Giemsa stain is also desirable. A Perls' stain does not often give useful information and is not essential in every patient. The need for other histochemical or immunohistochemical stains is determined by the clinical circumstances and the preliminary findings. Trephine biopsy sections should be examined and reported in a systematic manner, assessment being made of the bones, the vessels and stroma, and the haemopoietic and any lymphoid or other tissue. Assessment should begin with a very low power objective, the entire section being examined. Further examination is then done with an intermediate and high power objective. Ideally, reporting of trephine biopsy sections should be done by an individual who is competent in both histopathology and haematology, and who is able to make an appropriate assessment of both the bone marrow aspirate and the trephine biopsy sections. When this is not possible, there should be close consultation between a haematologist and a histopathologist. The report should both describe the histological findings and give an interpretation of their importance. A signed or computer authorised report should be issued in a timely manner. If the report is a preliminary, this must be clearly stated. (J Clin Pathol 2001;54:737-742)

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Section: Metastatic Tumourmentioning

confidence: 99%

Section: Metastatic Tumourmentioning

confidence: 99%

Bone marrow trephine biopsy

Bain¹

2001

Journal of Clinical Pathology

192

151

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“…Results from several studies indicate that 30%-50% of patients present with LD at the time of diagnosis. Proper staging of SCLC is important, since the disease stage determines therapy and subsequently prognosis [3,4,5,6,7]. Frequently observed sites of tumour manifestation in ED include, in declining frequency, skeleton, liver, pleura or pleural effusion, retroperitoneum, soft tissue, bone marrow, brain and contralateral lung lobe [3,4,5,6].…”

Section: Introductionmentioning

confidence: 99%

FDG-PET imaging for the staging and follow-up of small cell lung cancer

et al. 2001

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The staging procedures for small cell lung cancer do not differ appreciably from those for other forms of lung cancer. For practical purposes, the TNM stages are usually collapsed into a simple binary classification: limited disease and extensive disease. This study was performed to answer the question of whether fluorine-18 labelled 2-deoxy-2-D-glucose positron emission tomography (FDG-PET) imaging permits appropriate work-up (including both primary and follow-up staging) of patients presenting with small cell lung cancer, as compared with currently recommended staging procedures. Thirty-six FDG-PET examinations were performed in 30 patients with histologically proven small cell lung cancer. Twenty-four patients were examined for primary staging while four were imaged for therapy follow-up only. Two patients underwent both primary staging and up to four examinations for therapy follow-up. Static PET imaging was performed according to a standard protocol. Image reconstruction was based on an ordered subset expectation maximization algorithm including post-injection segmented attenuation correction. Results of FDG-PET were compared with those of the sum of other staging procedures. Identical results from FDG-PET and the sum of the other staging procedures were obtained in 23 of 36 examinations (6x limited disease, 12x extensive disease, 5x no evidence of disease). In contrast to the results of conventional staging, FDG-PET indicated extensive disease resulting in an up-staging in seven patients. In one patient in whom there was no evidence for tumour on conventional investigations following treatment, FDG-PET was suggestive of residual viability of the primary tumour. Furthermore, discordant results were observed in five patients with respect to lung, bone, liver and adrenal gland findings, although in these cases the results did not affect staging as limited or extensive disease. Moreover, FDG-PET appeared to be more sensitive for the detection of metastatic mediastinal and hilar lymph nodes and bone metastases. Finally, all findings considered suspicious for tumour involvement on the other staging procedures were also detected by FDG-PET. It is concluded that FDG-PET has potential for use as a simplified staging tool for small cell lung cancer.

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“…New algorithms for staging SCLC and prognostic models in extensive stage have thus been constructed. In the algorithm proposed by Richardson et al , 14 the least expensive sequence of procedures would save $US1418 per patient, compared with the application of a standard set of staging procedures to all patients.…”

Section: Pretreatment Prognosticationmentioning

confidence: 99%

Imaging and Staging of Small‐cell Lung Cancer: Is There a Future Role for Octreotide Scintigraphy?

Stokkel¹,

Kwa

Pauwels³

1995

Int J Clinical Practice

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SUMMARY In small‐cell lung cancer (SCLC), CT scan remains the most accurate imaging modality for evaluating local extension and specific sites of metastatic disease. The role of nuclear medicine in the work‐up of SCLC is still limited to the detection of bone metastases. Recently, a new potential diagnostic tool has been introduced based on the presence of somatostatin receptors in SCLC. With the use of radiolabelled somatostatin analogues it is hoped that an equally effective but simpler staging system has been found that gives a better separation of prognostic subgroups. This article reviews the role of nuclear medicine in general and somatostatin receptor scintigraphy in particular in the imaging and staging of SCLC. Clinical value in terms of sensitivity and specificity is discussed in relation with other imaging and staging modalities.

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Application of an Algorithm for Staging Small-cell Lung Cancer Can Save One Third of the Initial Evaluation Costs

Abstract: An algorithm consisting of a set of sequential staging procedures can accurately stage disease in patients with small-cell lung cancer and save more than one third of the costs of an inclusive standard set of staging procedures.

Cited by 23 publications

References 55 publications

Bone marrow trephine biopsy

Bone marrow trephine biopsy

FDG-PET imaging for the staging and follow-up of small cell lung cancer

Imaging and Staging of Small‐cell Lung Cancer: Is There a Future Role for Octreotide Scintigraphy?

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