Lung Cancer Staging Completed with U/S Guided Approach
A February issue of the Journal of the American Medical Association includes a report that validates use of minimally invasive approaches to stage lung cancer. A research team from the Mayo Clinic College of Medicine compared the diagnostic accuracy of three different approaches and combinations of those methods to determine the status of mediastinal lymph nodes.
The three methods compared were endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA), transesophageal endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), and traditional transbronchial needle aspiration (TBNA). Each of the procedures was completed sequentially as a single, unified procedure. Findings from each were compared to pathologic assessment of specimens and clinical follow-up at six and twelve months.
Almost 140 patients participated in the trial, 42 of them had disease in their lymph nodes. EBUS-FNA had a higher rate of sensitivity than TBNA. However, the combination of both EUS-FNA and EBUS-FNA had even superior sensitivity at 93 percent and 97 percent negative predictive value. This combined approach was also more effective in the assessment of patients who did not have enlargement of lymph nodes visible with CT.
The researchers note that mediastinoscopy could have been avoided in almost 30 percent of the cases if the ultrasound assisted studies were completed first. The combination of EBUS and EUS had a high rate of correctly labeling patients who were, in fact, negative for disease to mediastinal nodes.
The standard approach to complete staging among lung cancer patients is mediastinoscopy. This is an invasive procedure completed under general anaesthesia to assess the presence of malignancy in mediastinal lymph nodes. Alternative procedures used include PET and CT, both of which have high rates of both false-positive and false-negative findings.
It appears, based on this preliminary data, that EBUS and EUS may be an appropriate alternative to evaluate disease staging in patients with lung cancer. Mediastinoscopy can be reserved for those patients who have negative findings from both the other assessment methods.
March 18, 2008 Related topics: Pulmonary, Diagnostic, Surgery, Hematology & Oncology