PURPOSE: Accurate staging allows assessment of prognosis and determines treatment plans in patients with lung cancer. Current mediastinal staging methods include mediastinoscopy and CT-PET. Our aim is to develop a new minimally invasive staging algorithm in lung cancer featuring EBUS as a safe alternative for mediastinoscopy.
METHODS: Mediastinal lymphnode aspirations were performed using OLYMPUS Ultrasonic Linear Bronchoscope BF-UC260F. Tissue samples were obtained using 22G needle and processed using a thin layer technique and stained with PAP. Any residual material was processed as a cell block.
RESULTS: From May 2005 until Mar 2007 we performed 300 EBUS procedures. There were 153 positive aspirations for malignancy: 124 cases of Non Small Cell Lung Cancer, 23 Small Cell Lung Cancer and 6 mixed tumours. The most frequently (in order) sampled lymphnode stations were: 7, 4, 10, 11, 2 and 3. There were 7 false negative results. 87 primary tissue diagnoses were obtained and 137 mediastinoscopies were avoided. There were no complications. EBUS sensitivity was 94% with accuracy 96%. 19 patients with N2 negative EBUS pathology went on to have further staging with mediastinoscopy. Four of those patients proved to be N2 positive on mediastinoscopy. Two of these patients had N2 negative CT-PET. Two patients who had negative EBUS had negative mediastinoscopy too but were found to be N2 positive on final pathology after tumour resection.
CONCLUSION: EBUS in conjunction with CT –PET should be considered as a safe and effective alternative for mediastinoscopy in the staging algorithm in lung cancer.
CLINICAL IMPLICATIONS: It is estimated that approximately 70% of mediastinoscopies could be avoided when EBUS is fully established. We believe that EBUS is a highly sensitive staging tool in lung cancer and that it may offer a useful role in the re-staging of patients (stage IIIA) after neo-adjuvant therapy. Moreover, careful evaluation of mediastinal and hilar lymphnodes with EBUS provides very accurate, minimmaly invasive staging in lung cancer thus assists planning non-surgical but radical treatment with chemo-radiotherapy.
DISCLOSURE: Kristopher Skwarski, No Financial Disclosure Information; No Product/Research Disclosure Information