Procedures: Advancements in Lung Cancer Diagnostics and Treatment |

Pulmonary Fellows and the 2-Tube Approach for Mediasinal Staging of Non-small Cell Lung Cancer FREE TO VIEW

Amritpal Nat, MD; Vipul Jain; Daya Upadhyay; Michael Peterson; Pravachan Hegde
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UCSF-Fresno, Fresno, CA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):977A. doi:10.1016/j.chest.2016.08.1083
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SESSION TITLE: Advancements in Lung Cancer Diagnostics and Treatment

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 26, 2016 at 08:45 AM - 10:00 AM

PURPOSE: For Non-small Cell Lung Cancer (NSCLC) staging, combined endobronchial ultrasonography fine needle aspiration (EBUS-FNA) and endoscopic ultrasonography fine needle aspiration (EUS-FNA) is recommend by the current European Respiratory Society and European Society of Thoracic Surgeons guidelines over either test alone. Currently, many major teaching institutions in Europe and Canada are using combined EBUS and EUS staging in the same setting, performed by a single experienced operator. However, to our knowledge, only a few institutions in the United States perform combined endoscopic staging for lung cancer in a single setting. In this study, our goal is to evaluate the utility of combined EBUS and EUS staging of the mediastinum for NSCLC in a single setting in an ACGME accredited pulmonary fellowship training program.

METHODS: We studied all patients who had staging for NSCLC from September 2015 to March 2016 prospectively. Endoscopic staging by combined EBUS-EUS-FNA was performed by a dedicated interventional pulmonology (IP) trained specialist with an assistance of pulmonary fellow. All PET positive lymph nodes, lymph nodes >1 cm including the celiac axis lymph nodes and enlarged adrenal glands were sampled when indicated. At least 2 to 3 different stations were sampled each time and a minimum of 3 passes were made on the particular station being accessed. Stations 2R, 4R, 10 and 11 were sampled through EBUS. Stations 2L, 4L, 7, 8, 9 and accessible structures under the diaphragm were sampled through EUS. The primary outcome measure was the diagnosis of malignancy or abundant lymph node tissue determined by an experienced pathologist.

RESULTS: Combined EBUS-EUS staging were performed in a total of 71 patients. The primary outcome measures were achieved in 98.5% (70/71) of patients. Of these, inferior mediastinal nodal involvement was seen in 11% (8/71); while, left adrenal gland involvement was seen in 4% (3/71) of patients; as these structures are accessible by EUS but not by EBUS or standard cervical mediastinoscopy techniques alone. None of our patients had to undergo staging cervical mediastinoscopy. A minor complication, lymphadenitis was noted in 1% (1/71); while, no major complications were seen in our patients.

CONCLUSIONS: Combined EBUS-EUS staging performed by a trained IP specialist is sensitive, safe and cost effective procedure.

CLINICAL IMPLICATIONS: Because of the accessibility to the mediastinal and inferior mediastinal nodes, and the structures below the diaphragm such as, left adrenal, combined EBUS-EUS procedure will highly likely upstage the patients compared to the EBUS and standard cervical mediastinoscopy alone. We feel that pulmonary trainees should be trained in combined EBUS-EUS by an experienced IP specialist, as this procedure may have a tremendous potential of becoming the new gold standard in mediastinal staging for NSCLC in future.

DISCLOSURE: The following authors have nothing to disclose: Amritpal Nat, Vipul Jain, Daya Upadhyay, Michael Peterson, Pravachan Hegde

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