However, since a chest x-ray is only two-dimensional and has a low resolution, it will miss small (or hidden, early stage) lung cancers. Eventually a more detailed type of 3d x-ray scan, called a ct chest scan, is needed to accurately visualize the anatomy of the lung cancer and extent of spread. Frequently, ct chest scans can be performed in conjunction with a type of nuclear medicine
scan (e.g. Pet scan
or bone scan
), which can help identify if the tumor has spread to lymph nodes, distant organs or bones.
After adequate visualization of the lung cancer, the only definitive way to prove that it is actually a cancer (and also to determine the type of cancer) is to obtain a biopsy
. A pulmonologist can perform an outpatient procedure called a flexible bronchoscopy
in which a fiber
-optic probe is passed into the lung though the nose, and biopsy samples are obtained for diagnosis. Sometimes an interventional radiologist can direct a needle through the skin and chest wall under x-ray guidance to target the tumor and also obtain a biopsy. Another more invasive option is for a thoracic surgeon to confirm the diagnosis and stage of the lung cancer by performing surgical resection of the lung containing the tumor. In some cases, a special type of test called a mediastinoscopy
can be used to obtained biopsies of lymph nodes in the chest. This is needed to accurately determine the stage of certain types of lung cancer, and therefore guide the correct therapy.