HJBR May/Jun 2022

56 MAY / JUN 2022 I  HEALTHCARE JOURNAL OF BATON ROUGE ONCOLOGY DIAL GUE COLUMN ONCOLOGY There are many new developments in tho- racic oncology that help us answer these questions of diagnosis, staging, and treat- ment, including a broadening of the lung cancer low-dose CT screening (LDCT) for early detection and minimally invasive surgical techniques. These advances have accounted for a significant improvement of survival rate and decreased postopera- tive pain. Lung cancer — Screening Update Approximately 75% of lung cancer cas- es are diagnosed in an advanced stage, 1 typically found once the patient becomes symptomatic. Lung cancer continues to be the No.1 cancer killer in the United States; however, a new quasi-experimental study published in the British Medical Journal demonstrated significantly more cases of early non-small cell lung cancer (NSCLC) were caught following the introduction of the low-dose CT screening recommenda- tions nearly a decade ago. 2 From the U.S. Preventive Services Task Force (USPSTF) 2013 recommendations of high-risk cur- rent and former smokers, the percentage of patients between 55-80 presenting with stage I NSCLC increased by 3.9% annually over the next 4 years. The study also demon- strated an increase in the number of patients that would be diagnosed a full stage lower — stage I rather than II, or II rather than III — from 2.3% annually in the years before the USPSTF recommendations to 8.7% in the years after. Based on this study, researchers calculated this shift toward early detection of lung cancer from 2014 to 2018 improved survival rates, which averted an estimated 10,000 deaths. In 2021, the USPSTF annual screening rec- ommendations for lung cancer with LDCT were updated and approved by the Centers for Medicare and Medicaid Services (CMS) from the 2013 version, allowing for patients at higher risk greater access to screening. New USPSTF recommendations for annual LDCT screening widened the age range from 50-80 (previously 55-80) and decreased the pack year history to 20+ pack years (previ- ously 30+ pack years) of current smokers or people who have quit within the past 15 years. With this increase in the number of screened patients, we anticipate a continued improvement in survival rate by increasing detection of early-stage lung cancers. Minimally Invasive Approach to Lung Cancer When addressing a potential lung can- cer, there are new minimally invasive plat- forms that allow for diagnosis and staging to occur within the same anesthetic event. A CT-guided needle biopsy can prove chal- lenging to diagnose early-stage lung cancer, as the radiologists are essentially aiming for a small pulmonary nodule on moving lung parenchyma as the patient breathes. While CT-guided needle biopsies are undoubt- edly still a great option for diagnosis when compared to an open lung biopsy through a video-assisted thoracoscopic surgery (VATS) or open thoracotomy, there are new plat- forms that allow for robotic navigation to the pulmonary nodule through a bronchos- copy. These navigational bronchoscopies can use a CT scan for mapping to a pulmo- nary nodule while having a real-time vision of the airway during navigation to the target. These platforms can reach small to large nodules, whether medially or peripherally, making it a more reliable way to diagnose and detect early-stage lung cancers. If the biopsy confirms malignant cells through frozen pathology, pairing this procedure with an endobronchial ultrasound (EBUS) for lymph node biopsy allows for staging of the mediastinum in the same anesthetic setting. These devices have the potential to improve the diagnostic yield in sampling peripheral lung nodules and may play a role in the treatment of nonoperable or Surgical Advances in THORACIC ONCOLOGY When having discussions with patients about a new, potential malignancy found on a scan, there are three questions that nearly every patient asks: What is it? What stage is it? How is it treated?