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Lung cancer epidemiology, presentation and survival
P70 Can Endobronchial Ultrasound (EBUS) Guided Transbronchial Needle Aspiration (TBNA) be Used as a First Line Investigation in the Diagnosis of Central Lung Parenchymal Lesions?
  1. S Leyakathali Khan,
  2. M Haris,
  3. S Diver,
  4. B Miller,
  5. M Munavvar
  1. Royal Preston Hospital, Preston, UK

Abstract

Background Accurate diagnosis and staging remains a cornerstone in the management of patients with lung cancer. EBUS-TBNA has been demonstrated to be a safe and minimally invasive tool to evaluate mediastinal and hilar lymph nodes in patients with suspected lung cancer. It has also shown to be effective in sampling central lung parenchymal lesions with no obvious bronchoscopic findings. The aim of the study was to evaluate the role of EBUS TBNA as an early investigative tool in the diagnosis of lung cancer with central lung parenchymal lesions.

Methods Retrospective study of 119 consecutive patients who had EBUS-TBNA from paratracheal and peribronchial masses between January 2009 and February 2012. All patients had a non-diagnostic flexible bronchoscopy just before having EBUS. 15 of these also had mediastinal or hilar lymph node sampling at the time of procedure.

Results N=119, mean age 68 years (SD 10); male: female, 56(%): 63(%). 37 paratracheal and 82 peribronchial lesions were identified using convex-probe EBUS. 5 with no further data were excluded.

Of the 114 samples, 110 were diagnostic confirming lung malignancy 107(97%), lymphoma 1 (1%) and bronchial cysts 2(2%); 1 sample was insufficient and 3 showed no malignant cells (1 had surgical biopsy confirming squamous cell carcinoma, 1 was benign on follow imaging, 1 had CT guided biopsy positive for adenocarcinoma, 1 was not suitable for further invasive tests but CT showed progressive changes suggestive of lung malignancy).

Of the 107 lung malignancy, 31 were adenocarcinoma, 34 squamous cell carcinoma, 25 small cell carcinoma, 12 non-small cell carcinoma – not otherwise specified (NOS), 3 malignant cells - NOS and 2 extrapulmonary metastases. The sensitivity of EBUS-TBNA for the diagnosis of lung cancer was 97% (95% confidence interval 92–99%) with a negative predictive value 56% (95% CI 26–83%).

Conclusion Our results show that EBUS TBNA has a very high sensitivity in the diagnosis of central lung masses related to lung cancer. It could be used as a “one stop” as an early minimally invasive tool in the lung cancer diagnostic pathway to enable accurate diagnosis and a negative result may warrant other invasive tests.

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