How are imaging studies and bronchoscopy used in the workup of Lambert-Eaton myasthenic syndrome (LEMS)?

Updated: May 23, 2019
  • Author: David E Stickler, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Answer

SCLC is the malignancy most frequently associated with LEMS. In all adult patients with LEMS, diagnostic imaging (eg, computed tomography [CT] or magnetic resonance imaging [MRI]) of the chest for cancer detection should be performed. Screening strategies may help to detect SCLC in patients with newly diagnosed LEMS and therefore offer a better approach to treatment.

If imaging findings are negative in a patient with a substantial risk of having lung cancer, bronchoscopy should be performed. If both imaging and bronchoscopy results are initially negative and risk factors for lung cancer are present, positron emission tomography (PET) scanning should be considered. If all imaging study results are negative in such patients, periodic reassessment thereafter is indicated.

In a large cohort study, Titulaer et al screened for tumors using various methods (CT, radiography,18 F-fluorodeoxyglucose PET (FDG-PET), bronchoscopy, or mediastinoscopy) and found that CT of the thorax detected 93% of the tumors. [7]


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