Detection and diagnosis of the primary tumor in lung cancer

The role of radiology in the initial detection and diagnosis of primary lung cancer is well established. Recent advances in the detection of lung cancer stem from research into the visual search patterns used by a radiologist when reading a chest radiograph. Computer feedback of "visual-dwell" positions can lead to an increase in true-positive detection of lung nodules and decrease the false-positive rate. Plain film radiography and CT continue as the mainstays for the characterization of lung nodules. New studies involving the use of conventional tomography to detect contrast enhancement of malignant lesions and the use of axial multiplanar reconstruction CT to demonstrate involvement of pulmonary veins by malignant lesions are detailed. Transbronchial and percutaneous transthoracic biopsy techniques are widely used to diagnose the nature of solitary pulmonary nodules. The dependent positioning of the biopsy site has been shown to decrease both the pneumothorax rate and the frequency of chest drain insertion, whereas the blood patch technique was shown not to affect the pneumothorax rate at all.