Introduction Lung cancer is the leading cause of cancer related death in the Western World.1 Accurate staging is required to identify those patients with localised Non Small Cell Lung Cancer (NSCLC) who have resectable disease. Patients with Small Cell Lung Cancer (SCLC) or T4,N2-3 or M1 NSCLC are not suitable for surgery. Endoscopic ultrasound (EUS) with fine needle aspiration (FNA) can help obtain a tissue diagnosis where Endobronchial Ultrasound (EBUS)-FNA or CT guided biopsy is not possible.2
Methods We performed a retrospective search of prospectively recorded data on all patients who were referred for EUS-FNA between 2012 and 2015 for the following indications:
Suspicious lung mass with or without associated lymphadenopathy. This group has been subdivided into those who underwent EUS-FNA to obtain a tissue diagnosis and those who already had a tissue diagnosis and the EUS-FNA was performed for tumour staging.
Suspicious mediastinal or epigastric lymph nodes alone. This group has been subdivided into those for whom EUS-FNA was performed to investigate possible recurrence of previously resected lung cancer and those who had unexplained mediastinal or epigastric lymphadenopathy.
Procedure: The EUS-FNA procedures were all undertaken by AJS or SP, with a 22 g FNA needle (Cook Ltd), using a standard linear echoendoscope with ultrasound (Pentax Ltd & Hitachi Ltd). We collected data on patient demographics, EUS findings and procedures, cytology and prior pathology and radiology using our electronic clinical reporting system
Results 35 patients were referred for EUS-FNA for the diagnosis or staging of lung cancer during the study period. 2 patients were unsuitable candidates. 25 patients had a suspicious lung mass and 8 had suspicious lymph nodes alone.
In the group with a suspicious lung mass, EUS-FNA led to a diagnosis of lung cancer in 15 patients with 7 patients having benign pathology. 3 patients already had a diagnosis of lung cancer; EUS-FNA led to upgrading of tumour stage in 1 patient.
In the group with suspicious lymph nodes alone, 3 diagnoses of lung cancer were made. Of the remaining 5 patients, 4 had benign pathology and 1 had gastric cancer. No procedural complications were encountered in any patient.
EUS-FNA therefore led to a diagnosis of lung cancer in 60% (18/30) of the cases referred without a prior diagnosis.
Conclusion EUS-FNA is a useful modality in the diagnosis and staging of lung cancer when EBUS and/or CT guided biopsy fail to obtain a tissue diagnosis.
References 1 Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–917.
2 Colella S, Vilmann P, Konge L, et al. Endoscopic ultrasound in the diagnosis and staging of lung cancer. Endoscopic Ultrasound. 2014;3(4):205–212.
Disclosure of Interest None Declared
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