PURPOSE: EBUS-TBNA is rapidly gaining widespread acceptance as the standard of care for the mediastinal staging of lung cancer. Its role in the initial diagnosis of lung cancer is less clear. Since 85% of patients with lung cancer present with advanced disease, it seems plausible that in selected patients performing EBUS-TBNA as the initial invasive test might reduce the need for multiple invasive tests for diagnosis and subsequent staging. In our practice, most patients with lung cancer who do not have evidence of distant metastases undergo EBUS-TBNA for mediastinal staging.
METHODS: We reviewed a series of consecutive patients undergoing EBUS-TBNA for diagnosis and mediastinal staging of known or suspected lung cancer over a 6-month period that had undergone at least one invasive test for diagnosis or staging prior to EBUS-TBNA.
RESULTS: Eighty-eight patients out of 312 met inclusion criteria. If bronchoscopy with EBUS-TBNA had been the initial test it would have avoided 1 or more invasive procedures in 44 patients (50%), and would have been the only invasive procedure in 42 (47.7%). If EBUS-TBNA had been performed first, 14 of 42 (33%) tranthoracic needle aspirates would have been avoided. All 17 patients who underwent standard bronchoscopy for diagnosis of lung cancer prior to EBUS-TBNA could have been diagnosed and staged with a single procedure. In patients who underwent 2 or more invasive tests, EBUS-TBNA could have avoided at least 1 invasive test in 16 (59%) out of 27 patients.
CONCLUSION: Bronchoscopy with EBUS-TBNA as the initial invasive test could obviate additional invasive testing in a significant number of patients with lung cancer.
CLINICAL IMPLICATIONS: Bronchoscopy with EBUS-TBNA is a reasonable initial diagnostic test in selected individuals with suspected lung cancer who do not have clinical evidence of distant metastases and may reduce the need for additional invasive testing in these patients.
DISCLOSURE: Francisco Almeida, No Financial Disclosure Information; No Product/Research Disclosure Information