Imaging

Small Cell Lung Cancer

Preliminary Diagnosis: Small Cell Lung Cancer

I. What imaging technique is first-line for this diagnosis?

CT of the chest with IV contrast.

II. Describe the advantages and disadvantages of this technique for diagnosing small cell lung cancer.

Advantages

  • Can adequately assess the T stage of the tumor.

  • Useful for identifying pleural nodules, pleural plaques, pleural/ pericardial effusions, or metastasis.

  • Higher sensitivity than PET/CT at visualizing brain metastases.

  • CT of the chest should include upper abdomen to assess for adrenal metastasis.

  • Easily accessible at most medical facilities.

  • Better tolerated in obese or claustrophobic patients.

Disadvantages

  • Low sensitivity (40-84%) and specificity (57-94%) for identifying mediastinal and lymph node involvement.

  • Limited in detecting chest wall or parietal pleural invasion.

  • Requires the use of IV contrast.

  • Exposure to ionizing radiation.

III. What are the contraindications for the first-line imaging technique?

  • Contraindicated in pregnant patients, especially during the first and second trimesters.

  • Relative contraindication in patients with iodine allergies.

  • Relative contraindication in patients with renal failure.

IV. What alternative imaging techniques are available?

  • PET/CT (commonly used as adjunct to chest CT for full staging)

  • MRI of chest

  • Chest X-ray

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing small cell lung cancer.

PET/CT

Advantages

  • Delineates anatomy and also determines metabolic activity of lesions.

  • Improved sensitivity (98%) versus CT alone at identifying mediastinal invasion and lymph node metastases.

  • Improved sensitivity and specificity versus CT alone for detecting extrathoracic metastatic disease.

  • Can drastically alter management by correctly staging patients as limited or extensive stage, which ultimately dictates treatment course.

  • Helps with radiation treatment planning and assessing disease response after definitive therapy.

Disadvantages

  • Expensive and not easily accessible at certain medical centers.

  • Good positive predictive value, but poor negative predictive value.

  • High false positive rate, which may require further pathologic confirmation.

  • Sensitivity not as high in visualizing brain metastases.

MRI of chest/abdomen/brain with IV contrast

Advantages

  • Can help better assess extrathoracic and chest wall invasion.

  • Does not expose patient to ionizing radiation.

  • Can help delineate brain, adrenal, or spinal metastases.

  • Higher sensitivity than PET/CT at visualizing brain metastases

  • MRI of the brain with contrast should be obtained in all patients with suspected or confirmed diagnosis of small cell lung cancer prior to starting therapy

Disadvantages

  • Expensive.

  • Time consuming.

  • Requires significant patient cooperation to minimize motion artifact.

  • Loss of signal from physiologic lung movement.

  • Not as well tolerated in patients that are obese, claustrophobic, or unable to hold their breath.

Chest X-ray

Advantages

  • Cheap, easily accessible, and easy to administer.

  • Requires lower doses of radiation exposure.

  • Is helpful to compare with previous films to determine if further workup is necessary.

Disadvantages

  • Unable to determine full staging of disease.

  • Insufficient to assess mediastinal and lymph node metastases.

  • Cannot determine extrathoracic metastases.

VI. What are the contraindications for the alternative imaging techniques?

PET/CT

  • Contraindicated in pregnant women.

MRI chest/abdomen/brain with IV contrast

  • Contraindicated in patients with pacemakers and other implantable, MRI-incompatible devices.

  • Gadolinium contrast is contraindicated in patients with a GFR ≤ 30

CXR

  • There are no major contraindications for this imaging modality. Some institutions may require consent for pregnant patients.

You must be a registered member of ONA to post a comment.

Sign Up for Free e-newsletters

Regimen and Drug Listings

GET FULL LISTINGS OF TREATMENT Regimens and Drug INFORMATION

Bone Cancer Regimens Drugs
Brain Cancer Regimens Drugs
Breast Cancer Regimens Drugs
Endocrine Cancer Regimens Drugs
Gastrointestinal Cancer Regimens Drugs
Genitourinary Cancer Regimens Drugs
Gynecologic Cancer Regimens Drugs
Head and Neck Cancer Regimens Drugs
Hematologic Cancer Regimens Drugs
Lung Cancer Regimens Drugs
Other Cancers Regimens
Rare Cancers Regimens
Skin Cancer Regimens Drugs