PURPOSE: Recently published guidelines recommend mediastinal sampling for staging patients with ACCP radiographic group B or C lung cancer. Routine mediastinal sampling is not recommended for patients with group D disease. Endoscopic ultrasound-guided transesophageal and transbronchial FNA (EUS and EBUS respectively) are gaining popularity for mediastinal staging. To determine the potential usefulness of EUS and EBUS for lung cancer staging we reviewed our results and stratified them by ACCP radiographic group.
METHODS: Records were reviewed for all patients who underwent EUS and/or EBUS between 3/1/06 and 4/1/08. Patients were stratified based on imaging criteria (CT and/or PET) into ACCP group A, B, C or D based on published guidelines. Biopsy results were classified as ”Positive“ if malignant cells were seen, ”Negative“ if normal lymphocytes were seen in abundance, or ”Non-diagnostic“ if no evidence of either cancer or lymph node was seen.
RESULTS: 127 patients met inclusion criteria. Of these, 86 had a known or presumed diagnosis of lung cancer, and 84 had ACCP group B, C or D disease. The rate of positive biopsy was 59% (17/29), 9% (3/32), and 9% (2/23) for groups B, C and D respectively. The rate of non-diagnostic biopsy was 3% (1/29), 28% (9/32), and 9% (2/23) respectively.
CONCLUSION: Although mediastinal sampling of patients with ACCP group D disease is not recommended, we found that detection of mediastinal disease by endoscopic ultrasound-guided FNA was similar between groups C and D patients. Importantly, the incidence of non-diagnostic biopsies in patients with group D disease was low.
CLINICAL IMPLICATIONS: Selected patients with ACCP radiographic group D lung cancer may be appropriate candidates for EUS and/or EBUS.
DISCLOSURE: Mark Block, None.