Endobronchial ultrasound has edge for lung cancer staging
By Afsaneh Gray, medwireNews Reporter
29 November 2013
Thorax 2013; Advance online publication

medwireNews: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a better primary procedure than endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for staging non-small-cell lung cancer, study results suggest.

The randomized controlled trial looked at the benefits of different sequences of the procedures (EBUS-TBNA first, followed by EUS-FNA, or vice versa) and found that both sequences were equally good at staging lung cancer, but that the added value of EBUS-TBNA after EUS-FNA was significant.

“The necessity for EBUS-TBNA following EUS suggests that EBUS-TBNA is a better primary procedure in endoscopic mediastinal staging of potentially operable lung cancer,” write study authors Bin Hwangbo (National Cancer Center, Goyang, Korea) and colleagues.

A total of 160 patients with histologically confirmed or strongly suspected potentially operable non-small-cell lung cancer were recruited from the National Cancer Center and randomly assigned into two groups of 80 patients each. Group A had the EBUS-TBNA procedure first (EBUS-centered) and Group B had EUS-FNA before EBUS-TBNA (EUS-centered).

To avoid tumor location bias, stratified randomization was applied according to tumor location.

Diagnostic values were evaluated for 74 patients in each group. The diagnostic accuracy for Group A was 93.2% while for Group B it was 97.3%, a nonsignificant difference. Sensitivity in detecting mediastinal metastases was also similar between the two groups, at 85.3% and 92.0%, respectively.

The additional benefit of adding EUS-FNA after EBUS-TBNA in Group A was minimal, with accuracy increasing from 91.9% to 93.2%, and sensitivity increasing from 82.4% to 85.3%. However, Group B benefited markedly from the addition of EBUS-TBNA, with accuracy rising from 86.5% to 97.3%, and sensitivity increasing from 60.0% to 92.0%.

In Group B the additional gain from EBUS-TBNA was observed primarily in patients with right-sided tumors, although some people with left-sided tumors also benefited.

No differences were observed between the two groups in procedure time, cardiorespiratory parameters, complications, procedure difficulty or patient satisfaction. However, the authors note in Thorax that “the EUS procedure is generally better tolerated than EBUS-TBNA.”

Nonetheless, “[t]he high diagnostic yield of EBUS-TBNA, small additional benefit of EUS and similar patient satisfaction between the two groups suggest that an EBUS-centred procedure or EBUS alone is preferable in mediastinal staging of lung cancer.”

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

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