S23 Role of Transoesophageal Fine-Needle Aspiration Using an Ultrasound Bronchoscope in Mediastinal Staging and Diagnosis of Lung Cancer
Objective To evaluate the role of transoesophageal fine-needle aspiration using an ultrasound bronchoscope (EUS-B-FNA) as an alternative means of diagnosing and staging lung cancer.
Methods This was a retrospective analysis of 132 cases of EUS-B-FNA between July 2008 and March 2012 in a large tertiary centre for respiratory medicine. EUS-B-FNA was performed with an OLYMPUS linear ultrasonic bronchoscope (BF-UM40) using a 21 Gauge needle. Samples were deposited into Cytolyte for cytological examination.
Results Of the 132 patients, 76 were male and 56 were female. The mean age was 69 years (range 40–86 years). No patients had a tissue diagnosis of malignancy prior to the procedure. 86 patients had a peripheral mass on CT, 43 had a mediastinal mass, and 3 patients had a new pleural effusion on CXR and mediastinal lymphadenopathy on CT scanning. EUS-B was used to sample subcarinal (n=100), L4 (n=46), R8 (n=4), R4 (n=2), R2 (n=2), L8 (n=1), L9 (n=1) and paragastric (n=1) lymph node stations. It was also used to sample RLL (n=4), RUL (n=3), LUL (n=3), LLL (n=1), paraoesophageal (n=2) and anterior mediastinal (n=1) masses. A left adrenal mass was sampled in 1 patient. EUS-B was used as a first line procedure in patients with enlarged lower mediastinal lymph nodes, reduced oxygen saturations (SpO2<90%) or FEV1 (<1.0L), and those with a poor performance status. It was also used as a second line procedure in patients who could not tolerate bronchoscopy or EBUS procedures, and those with normal brocnhoscopy or EBUS procedure. There were no complications and the procedure was well tolerated. Of the 132 cases, a tissue diagnosis was obtained in 100 patients. Samples revealed no malignant cells in 22 patients. Samples were insufficient for diagnosis in only 2 cases. Of the 22 negative samples, 11 patients were referred to Thoracic Surgery, all of these patients also had a negative staging mediastinoscopy and so underwent surgical resection. 6 patients went on to have a CT guided biopsy which provided a tissue diagnosis. 3 patients were not fit for further investigation and so were treated on the basis of a radiological diagnosis of lung cancer.
Conclusion EUS-B-FNA should be considered as a safe and effective investigation in the diagnostic and staging algorithm in lung cancer. It allows sampling of stations L4, 7 and 8, and is effective as a first line procedure in patients with reduced oxygen saturations or FEV1, and a poor performance status.