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LUNG CANCER EVALUATION CENTER - DIAGNOSTIC TESTING


About The Center

Stony Brook University Lung Cancer Evaluation Center
CONTACT INFO
Lung Cancer Evaluation Center
Practice Location:
3 Edmund D. Pellegrino Road
Stony Brook, NY 11794
Mailing Address:
Health Sciences Center
T-19, Rm 071
Stony Brook University
Medical Center
Stony Brook, NY 11794-8191
631-444-2981
631-444-6970
Map & Directions
Request an Appointment

Diagnostic Testing

CT Scan

A CT (computed tomography) scan uses special equipment to obtain images of multiple cross-sections of the body. CT images are more detailed than a conventional chest x-ray. It can show different types of tissue, including lungs, bones, soft tissue, muscle, and blood vessels. Modern CT scans use a method called spiral (helical) CT that takes pictures from different angles and, through the aid of a computer, produces cross-sectional images. All the CT scanners at Stony Brook are helical and multi-detector scanners. These technologies allow us to take images incredibly fast, so your study will be finished quicker. Additionally, these technologies allow us to see extremely fine detail, far better than older CT scanners.

CT Scan Sometimes a CT scan is ordered with contrast. Contrast material is injected into a vein to help blood vessels stand out more on images. Contrast helps the doctors interpreting the images to distinguish blood vessels from surrounding soft tissue. This is particularly helpful when looking in the middle of the chest. If you are asked to have a CT scan with contrast, you will be asked if you have any allergies to iodine, and you may need to have blood drawn to check your kidney function. When contrast material is injected, people may experience a flush of heat or a metallic taste in the mouth; this lasts for only a few minutes. If you experience itching, hives, swelling of the throat, or shortness of breath, let the technician know immediately, as this could be an allergic reaction to the contrast. The technician has medication to deal with this.

Please dress comfortably. Avoid clothes with metal, and take off jewelry, which can show up on the images. You will be asked to lie flat on your back, and periodically hold your breath. The CT scanner is a large machine with a padded table that slides through a large doughnut-shaped hole. A CT scan is not invasive and involves relatively low radiation. It can give the doctors more information than a routine x-ray, and is often useful in guidance during biopsy procedures.

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MRI of the Brain

Magnetic resonance imaging, known as MRI, uses strong magnets to generate images of the body. This technology is currently the best way for radiologists to diagnose tumors of the brain. MRI uses a very strong magnetic field; thus, any metal object will be pulled into the magnet. The technician who performs the MRI will ask if you have any metal implanted in your body, such as a heart pacemaker, implanted port/infusion catheter, prosthetic joints, metal plates, pins, or surgical staples. You will also be asked if you have a bullet or shrapnel in your body or have ever worked with metal. If there is any question of metal fragments, you may be asked to have an x-ray to detect their possible presence. You will be asked to remove hairpins, jewelry, eyeglasses, hearing aids, and removable dental work.

The conventional MRI unit is a closed cylindrical magnet in which the patient needs to lie completely still for several minutes at a time. The patient is placed on a sliding table and a radio antenna device, called a surface coil, is positioned around the upper part of the head. The technician will leave the room, but is able to communicate with you by using an intercom system. In general, the test can take 15-45 minutes, depending on how detailed the requested study must be. Some people may feel confined or claustrophobic. If this is a concern for you, please ask your primary care doctor to give you a sedative. Most bothersome to many people is the loud tapping or knocking noises heard at certain times during the test. The technician will offer you ear plugs to help. Sometimes an injection of contrast material through an IV line (intra-venous; into a vein) is needed. MRI contrast material is less likely to produce an allergic reaction than the iodine-based material used during CT (computed tomography) scans, and the potential for kidney damage is not a concern. Some people may experience a cool sensation at the injection site.

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PET-CT Scan

PET (positron emission tomography) scanning is an imaging technique that uses a radioactive tracer that is injected into the patient. Images of the body are produced, and degrees of brightness represent different levels of tissue or organ metabolism (chemical reactions that occur in cells). The substance injected into the patient is glucose (sugar) that has a radioactive material tagged to it. Areas of the body that use a lot of glucose, such as the brain and heart, will pick up this radioactive material and appear hot. Abnormal cells in the body that use a lot of glucose will also appear as "hot spots." Cancer cells are highly metabolic and use a lot of sugar. That's why this test is useful in aiding in diagnosing and staging cancer.

PET-CT Scan PET scans do not diagnose cancer; they only show areas of abnormal uptake of the tracer material. Other diseases can produce "hot spots," such as infection. In addition, false-positives (test results that are erroneously classified in a positive category) or false-negatives (test results that are erroneously classified in a negative category) can exist if a patient ate within a few hours of the test, or if the patient is a diabetic. Slow-growing cancers are hard to detect on PET, as well as cancers that are smaller than half an inch in size. PET scans are helpful in guiding the physician when a cancer is suspected. It can assist in the staging of a cancer, which is very important in determining the treatment plan. PET scans are also used to help the doctor determine whether a treatment is effective.

The radioactive material used is short-lived and radiation exposure is low. It is a non-invasive test. The radioactive material will be injected, and you will be asked to wait for about an hour; then your scan will be done. The scan can also take up to 1 hour to complete, depending on which parts of the body are being examined. The entire process for this test can take about 2 hours. You will be asked to lie still while the pictures are taken. The machine has a padded table on which you lie, and this table slides into a large, doughnut-shaped hole in the middle of the machine.
Preparing for PET Scan (instructions)  Back to Top

Pulmonary Function Test

The pulmonary function test (PFT) compares the function of your lungs to predictions based on your height, age, and weight. Abnormal test results can be caused by lung diseases, such as emphysema, scarring, and asthma, and also by abnormalities in your rib cage, abdominal diseases, and heart failure. The test measures the amount and speed of air moved in and out of your lungs. Nose clips are used to prevent air from escaping through your nose. You will need to be able to follow directions during the test. Please inform the technician if you expect problems related to hearing loss or need for an interpreter.

Please wear comfortable clothes that do not restrict your breathing. You will be asked to perform these breathing techniques several times. Sometimes a drug (broncho-dilator) is used that widens the air passages of the lungs and eases breathing; and you then repeat the test. The value of this test depends on your effort, so please try your best. The results are given in both raw data and as a percent of "predicted values" based on height, weight, and age. Your doctor may ask for blood to be drawn at the time of your test, to determine how much oxygen and carbon dioxide is in your blood. All this information is used to determine what type of treatment you are a candidate for. If surgery is seing discussed, a PFT will tell the surgeon how much lung can be removed or whether surgery is a good option at all. PFT's are often done for patients periodically during treatments to give the doctor an indication of how they are tolerating the treatment.

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Cardiac Stress Test

Often a cardiac stress test is indicated prior to any surgically procedure to assess your heart function and determine operative risk. There are numerous ways for this to be performed. If you are able, you may be asked to run on a treadmill to elevate your heart rate. If you are not able to exercise, then a medication can be injected through an IV line (intra-venous; into a vein) to mimic exercise. For instance, dobutamine (Dobutrex) can be used to elevate your heart rate. This medication is also the preferred drug for patients with chronic obstructive pulmonary disease (COPD), asthma, or an active wheeze. Other options are adenosine (Adenoscan) or dipyridamole (Persantine) which act as vasodilators, that is, they make your blood vessels open wider and thus increase blood flow.

If you take theophylline (Bronkodyl; Elixophyllin; Slo-bid; Slo-Phyllin; Theo-24; Theo-Dur; Theolair; Uniphyl), you cannot take it 24 hours prior to the test. This test is not recommended for patients who actively wheeze. Exercise treadmills and dobutamine stress tests depend on your heart rate. If you take medication such as a beta blocker, you may be asked to not take it for a few dosages. Often a nuclear stress test is ordered, in which images of your heart are taken at rest and during stress. These images give an indication of whether there are areas of poor blood flow to the heart muscle (perfusion ) and overall heart function.
Preparing for Cardiac Stress Test (instructions)

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Cardio Pulmonary Stress Test

Breathing problems may begin in the lungs, heart, or the system that circulates your blood. Sometimes your doctors will ask you to have a cardio-pulmonary stress test if they are unsure of why you are short of breath or they are concerned about the results of your pulmonary function test.

During the test you will be asked to walk on a treadmill or ride a stationary bicycle. Small pads (electrodes) will be placed on your body to monitor your heart. You will also wear nose clips and breathe through a mouthpiece.

Before you start to exercise, your heart rate, breathing, and blood pressure will be monitored. You will exercise as long as you can. Before the test and at the end of the test, a blood sample from an artery may be taken.

The cardio-pulmonary stress test measures your exercise capacity and identifies the cause of shortness of breath. This information may be useful in determining your operative risk and predicting how you will feel after lung resection.
Preparing for Cardio Pulmonary Stress Test (instructions)

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Bronchoscopy

Bronchoscopy allows your pulmonologist (lung specialist) to look into your airways and lungs. Bronchoscopy is used to evaluate and treat growths in the airway, diagnose and determine the extent of lung cancer, control bleeding, or remove objects blocking the airway. It can also be used to treat airway problems such as bleeding and obstruction.

There are two types of bronchoscopy: flexible or rigid. Flexible bronchoscopy is used whenever possible because it is more comfortable and does not require general anesthesia.

You may need to remove dentures, empty your bladder, and put on a hospital gown. Your heart rate, blood pressure, and oxygen level will be monitored during the procedure. You will be have an IV line (intra-venous; into a vein) placed in your arm, and receive medication to sedate (relax) you.

Prior to the placing the scope through your nose, an anesthetic ointment is given in the nose to numb your nasal passages to make you more comfortable. A local anesthetic in the form of a spray is given in your nose and mouth; this will numb your throat and reduce your gag reflex. More anesthetic is sprayed through the scope to numb your vocal cords. You may be asked to make a high-pitched sound while the scope is passed through the vocal cords.

You will not feel pain during the procedure, but you may feel pressure, or want to gag or cough. Therefore, most patients are given a mild sedative during the procedure; this will keep you comfortable even if you are not completely asleep. You may not eat or drink for about 2 hours, or until you can swallow without choking.

At 4-6 hours after the bronchoscopy, it is not uncommon to have shaking chills; this usually responds quickly to acetaminophen (Tylenol; 650 mg). A small amount of blood in your sputum is not uncommon after a biopsy. The following day you may feel tired, and have a low-grade fever, general muscle aches, or a sore throat. If you have any concerns about symptoms after a bronchoscopy, please call a physician at 631-444-2981 during business hours or 631-689-8333 on off-hours.

Results of a biopsy (tissue sample taken for analysis) may take 2-4 days to be available. As with most biopsies, a negative result does not prove that you don't have cancer. There is always the chance of a "false-negative" result-a test result that is erroneously classified in a negative category because of imperfect testing methods or procedures.
Preparing for Bronchoscopy (instructions)

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Fine-Needle Aspiration

Fine-needle aspiration is the name of the process of obtaining a sample of cells and bits of tissue for examination by applying suction through a thin, hollow needle attached to a syringe. The sample of cells and bits of tissue is called a biopsy.

Needle biopsies can be obtained through the chest wall into the lung. Lesions (abnormalities) That can be evaluated in this way are those that are large enough and on the outside of the lung. Not every lunglesion can be accessed with a needle.

Fine Needle Aspiration The skin is cleaned and numbed with anesthesia called lidocaine that causes loss of sensation to prevent pain. The needle is placed under radiologic imaging (usually fluoroscopy or CT scanning) to help guide the needle into the lesion. There should be minimal pain during the procedure, as most of the pain fibers can be numbed with anesthesia. Some patients cough up some blood, but this is uncommon and the amount of bleeding is usually very small.

Since the needle is puncturing the lung, the lung may collapse. The likelihood of lung collapse depends on how big the lesion is, the amount of emphysema (abnormal increase in the size of air spaces in the lung) near the lesion, and how deep the lesion is from the chest wall. Many patients with a lung collapse have only some mild chest discomfort and mild shortness of breath; if so, there is no treatment necessary.

If the lung collapses further, a small tube may need to be inserted to re-expand the lung until the hole stops leaking. If a tube is placed, you may require admission into the hospital for 1-2 days. The physician doing the biopsy will explain this to you prior to the procedure. Because of the risk of lung collapse, you will have x-rays performed after the biopsy and may require observation in the hospital for 3-4 hours after the biopsy.

Results of a biopsy may take 2-4 days to be available. The yield of needle biopsy is usually very high, but a negative result does not prove that you don't have cancer. There is always the chance of a "false-negative" result-a test result that is erroneously classified in a negative category because of imperfect testing methods or procedures.
Preparing for CT-Guided Needle Aspiration (instructions)

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Mediastinoscopy

Sometimes a biopsy of the chest's lymph nodes (pea-sized "glands" that filter impurities from the body) is needed to stage or diagnose lung cancer. This test is performed by a surgeon, who will make a small incision just above your breastbone, and slide a scope down next to your windpipe to remove some of these lymph nodes. The biopsy is performed under general anesthesia. It is done as an outpatient procedure. You will need to have pre-operative testing.

The results of the biopsy will be available in about 4-5 business days. Some people may complain of a sore throat. This will often resolve within a few weeks. If is does not, let your surgeon know. You will have a dressing over the incision, which can be removed after 24 hours, and then you may shower. There will also be small strips across the incision, which will fall off on their own within a few days or can be removed after a week.

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Thoracoscopy

Thoracoscopy is a procedure that can be performed by a surgeon to look in your chest. This can be performed to take a biopsy of your lung, to look at the pleura (the lining of the outside of your lung), to remove fluid that can collect in the space between the lung and chest wall, to remove a nodule, or to remove part of the lung. The surgeon will make a minimum of three small incisions on the side of your chest between the ribs. A scope is used to see inside of your chest. The surgeon is able to insert the surgical tools through the other two incisions, and perform the necessary procedure this way.

This operation is performed under general anesthesia and requires a stay in the hospital. You will need to have pre-operative testing. After the surgery you will have a drain, called a chest tube, placed in your chest. The tube helps to drain blood, fluid, and air from around the lung. It is put in the chest cavity through the skin, and is attached to a collection system. This tube will usually remain in for about a day or two after surgery. Sometimes it will have to stay in longer as necessary. Once the tube is removed, most people are able to go home that day or the following day.
Preparing for Lung Surgery (instructions)
Do's and Don'ts After Surgery (instructions)

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The Stony Brook Medicine University Physicians website is primarily an informational and educational resource. It should not be used in place of medical advice and recommendations you receive from your health care provider. If you have, or suspect that you have a medical problem or condition, please seek the advice of your health care provider.


Stony Brook Medicine University Physicians provides marketing advice and consultation to the clinical Faculty associated with the University Faculty Practice Corporations (UFPCs). It does not provide medical care directly or indirectly nor does it oversee, direct, manage or supervise the medical care provided by any of the individual Practices. The individual Practices are responsible for the medical care each Practice provides to its patients. Please note that the Practices listed below are separate University Faculty Practice Corporations (UFPCs).