More than 70% of patients with lung cancer are not candidates for a curative resection. Though many of these patients are symptomatic and may benefit from palliative therapy, available modalities fail to obtain a tissue diagnosis in up to 30% of patients. Endoscopic ultrasound (EUS) guided biopsy is a technique, not routinely used in lung cancer, that would allow sampling of lung masses and metastasis involving the mediastinum, liver and adrenals. The accuracy and feasibility of EUS was reviewed to define its role in lung cancer diagnosis and staging.
From March 2003 to January 2005, all patients at the Minneapolis Veterans Affairs Medical Center with suspected lung cancer and not candidates for curative surgery, were identified. Computed tomography (CT) and positron emission tomography scans were reviewed. Patients with lesions approachable by EUS were enrolled in the study. Outcomes were analyzed by final tissue diagnosis or serial imaging.
68 patients met inclusion criteria. Three patients refused further studies. The remaining 65 patients constituted the study population. EUS made a correct diagnosis in 57/65 patients (45 with malignant and 12 with benign pathology). 29% of these patients had undergone a failed prior attempt at tissue diagnosis. Over all, the sensitivity of EUS was 85%, specificity 100% and accuracy 88%. In the 8/65 patients were EUS failed to obtain a tissue diagnosis, EUS was technically infeasible in 3. Malignancy was confirmed in these 8 patients using video-assisted thoracoscopy (n=1), mediastinoscopy (n=3), CT guided biopsy (n=2) and bronchoscopy (n=1). Two complications of chest pain and hemoptysis were self-limited and resolved without intervention.
EUS provides an alternative method of tissue diagnosis for advanvced lung cancer that is highly safe and accurate.
EUS complements bronchoscopy and CT by reaching central areas that are traditionally difficult to access. If available, it should be consider along with bronchoscopy and transthoracic needle aspiration as a “first line” diagnostic procedure.
Rosemary Kelly, None.