Approach to Lung Cancer diagnosis and staging

Question 1

Change of malignancy for < 5 mm nodule

Answer 1

1%

Question 2

Chance of malignancy for > 20 mm nodule

Answer 2

> 50%

Question 3

Low risk nodule pretest probability

Answer 3

< 5%

Question 4

Intermediate risk nodule pretest probability

Answer 4

5-65%

Question 5

High risk nodule pretest probability

Answer 5

> 65%

Question 6

Ideal timing for workup on a lung nodule

Answer 6

within 6 weeks

Question 7

Sensitivity and specificity for CT chest in staging lung cancer

Answer 7

Sens. 55%
Spec. 81%

Question 8

Sensitivity and specificity for PET in lung cancer staging

Answer 8

Sens. 77%
Spec. 86%

Question 9

EBUS staging sensitivity and specificity

Answer 9

Sens. 92%
Spec. 100%

Question 10

Surgical staging of mediastinum sensitivity and specificity

Answer 10

Sens. 78%
Spec. 100%

Question 11

Should patients with enlarged mediastinal lymph nodes get biopsy regardless of PET activity?

Answer 11

Yes

Question 12

3 populations who should receive mediastinal staging even if PET negative nodes

Answer 12

Central tumor

Tumor > 3 cm

Enlarged N1 node

Question 13

Lymph node stations that should get surgical staging first rather than EBUS if all other nodes are negative on imaging

Answer 13

5 and 6

Question 14

Population that should be restaged by EBUS after induction treatment

Answer 14

Locally advanced stage III NSCLC

Question 15

4 indications to biopsy a nodule > 8mm

Answer 15

Evidence of growth

Clinical pretest probability and PET are discordant

Probability is 10-60%

Patient requests proof of diagnosis before surgery

Question 16

Stage I lung cancer treatment

Answer 16

Surgery or radiation

Question 17

Stage I lung cancer 5 year survival

Answer 17

68% (IB) - 92% (IA1)

Question 18

Stage II lung cancer treatment

Answer 18

Surgery and adjuvant chemo

Question 19

Stage II lung cancer 5 year survival

Answer 19

53% (IIB) - 60% (IIA)

Question 20

Stage III lung cancer treatment

Answer 20

Chemo and radiation with adjuvant immuno therapy

Question 21

Stage III lung cancer 5 year survival

Answer 21

13% (IIIC) - 36% (IIIA)

Question 22

Stage IV or recurrent lung cancer treatment

Answer 22

Chemo, targeted therapy
Immunotherapy
Palliative

Question 23

Stage IV or recurrent lung cancer 5 year survival

Answer 23

0% (IVB) - 10% (IVA)

Question 24

Drug indicated for resected IB - IIIA EGFR + NSCLC

Answer 24

Osimertinib

Question 25

Drug indicated for resectable lung cancer stage IB - IIIA

Answer 25

Nivolumab