SESSION TYPE: Endobronchial Ultrasound
PRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PM
PURPOSE: Accurate NSCLC tissue staging is critical to guide multi-modality therapy, including induction chemotherapy for stage II/III diseases. Fiberoptic bronchoscopy (FOB) is a minimally invasive technique used for LC diagnosis since 1969. Recent advances in navigational bronchoscopy and in Endobronchial-Ultrasound guided transbronchial needle-aspiration (EBUS-TBNA) of lymph nodes(LC) have improved diagnostic accuracy for peripheral and nodal stations respectively. There is debate whether both “primary” parenchymal lesions and regional nodes should be simultaneously sampled. We present a NSCLC series to determine the utility of such comprehensive tissue sampling.
METHODS: Review of IRB approved prospective FOB cases evaluating role of image-guided interventions in managing suspected thoracic malignancies. Between 11-2009 to 03-2012, 203 patients had bronchoscopy for possible thoracic malignancies. Of the bronchoscopically proven 103 LC cases, 93 were NSCLC. Excluding 9 central tumors, 84 cases has a peripheral lung primary (PLP). Of these 49 cases also had adenopathy and had both EBUS-TBNA and attempted sampling of peripheral mass by transbronchial biopsy (TBBX), transbronchial brushing or peripheral TBNA. These 49 cases with pathology confirmed diagnosis of NSCLC were analyzed.
RESULTS: The diagnostic yields of PLP sampling and EBUS-TBNA LN staging were 87.76% and 69.39% respectively. 57.14%(28/49) were positive in both sample sets. 12.24% (6/49) were diagnosed only by nodal sampling (unable to reach primary) and 30.61% (15/49) were diagnosed only by PLP sampling (benign reactive adenopathy or unsuccessful LN sampling).
CONCLUSIONS: In spite of advances in real-time (EBUS-TBNA) and image-guided navigational bronchoscopies, not all primary peripheral lesions can be reached and visualizing apparent EBUS-TBNA puncture of LN may yield only reactive lymphocytes or non-diagnostic cells. Unless bedside cytology assessment is 100% accurate, multi-target sampling will reduce need for repeat procedures.
CLINICAL IMPLICATIONS: Improvement in NSCLC outcome depending on nodal staging and promise of personalized therapies depends on definitive NSCLC cell-type and molecular mutation analysis. This may be best accomplished by comprehensive nodal sampling and harvesting adequate tumor tissue at time of bronchoscopy to test for a growing array of predictive and prognostic biomarkers.
DISCLOSURE: The following authors have nothing to disclose: Yuan Zhang, Yan Shang, Mingying Zeng, Rex Yung
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