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Pulmonary Procedures |

Effect of Endobronchial Ultrasound Guided Fine Needle Aspiration as Part of Non-small Cell Lung Cancer Staging on Rate of Unexpected N2/N3 Disease at Surgical Lymphadenectomy

James Dayton, MD; Magye Badgley, MD; Michael Skokan, MD; Wayne Strauss, MD
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The Oregon Clinic, Portland, OR


Chest. 2013;144(4_MeetingAbstracts):816A. doi:10.1378/chest.1704611
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Abstract

SESSION TITLE: EBUS and Lung Cancer

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 27, 2013 at 03:00 PM - 04:00 PM

PURPOSE: Non-small cell lung cancer (NSCLC) patients with mediastinal lymph node metastasis (N2/N3 disease), in general, do not benefit from surgical resection. Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is a method to sample mediastinal lymph nodes. Studies done in academic medical centers have demonstrated that EBUS-TBNA is sensitive and specific in identifying N2/N3 disease. We hypothesize that EBUS-TBNA at our community institution has reduced the rate of N2/N3 disease found at surgical resection.

METHODS: A retrospective review of patients with NSCLC who underwent surgical resection with lymphadenectomy or EBUS-TBNA from January 2004 through August 2011 performed at a single tertiary care, academic, community hospital. The patient population was subdivided into pre-EBUS, early EBUS and modern EBUS eras. The primary outcome of our study was comparison of the rate of unexpected N2/N3 disease found on lymphadenectomy between the pre-EBUS and modern EBUS cohorts. Secondary outcomes included sensitivity and diagnostic accuracy of EBUS-TBNA and the number of surgical lymphadenectomies.

RESULTS: 481 patients were included. The rate of unexpected N2/N3 disease at surgical resection for the pre-EBUS, early EBUS, and modern EBUS cohorts were 15.4%, 17.4%, and 12.6%, respectively. The difference between the pre-EBUS and modern-EBUS cohorts was not statistically significant (p = 0.4). The total number of resections with lymphadenectomy per year went from 78 to 68.2 after initiation of EBUS-TBNA (p=0.09), and to 42.5 in the 2010-011 subset. The sensitivity and diagnostic accuracy of EBUS-TBNA were 94.5 % and 95.8% respectively and did not vary between early-EBUS and modern-EBUS cohorts.

CONCLUSIONS: In our institution’s experience, EBUS-TBNA as part of a staging algorithm for NSCLC did not reduce the rate of unexpected N2/N3 disease at time of surgical resection. Importantly, the sensitivity and diagnostic accuracy of EBUS-TBNA in NSCLC staging was similar to that reported at university settings. Our results suggest EBUS-TBNA may reduce the number of surgical staging procedures.

CLINICAL IMPLICATIONS: EBUS-TBNA in a community hosptial setting is a good option for staging of non-small lung cancer and appears to decrease the need for invasive, surgical staging.

DISCLOSURE: The following authors have nothing to disclose: James Dayton, Magye Badgley, Michael Skokan, Wayne Strauss

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