Introduction NICE guidance for the diagnosis and treatment of lung cancer recommends choosing “investigations that give the most information about diagnosis and staging with the least risk to the patient”. EBUS-TBNA is expanding as an important diagnostic modality in lung cancer and provides simultaneous information on lung cancer phenotype, genotype and nodal staging. The impact of the introduction of EBUS-TBNA on the use of diagnostic modalities for tissue acquisition in patients with lung cancer is unknown.
Methods A retrospective review of 407 consecutive patients diagnosed with lung cancer at a university teaching hospital in 2007, 2009 and 2011. Data were collected on age, gender, FEV1, performance status, diagnostic modality, and pathological subtype. Patients where only a clinical diagnosis was made (n=21) were excluded.
Data were analysed using the SPSS version 17 (Chicago, IL, USA). For comparison between categorical variables, Chi-square or Fisher’s exact test were used as appropriate. All reported p-values are two-tailed, and are considered statistically significant when p<0.05.
Results 386 patients were included in the analysis. The mean (SD) age (years) and FEV1 (L/min) were 69 (12) and 1.81 (0.80) for 2007, 67 (10) and 1.81 (0.79) for 2009 and 68 (12) and 2.07 (0.68) for 2011 respectively. In 2007, 2009 and 2011 57.9%, 51.4% and 62.7% were males. The results on diagnostic modalities, performance status, histological subtype and staging are listed in Table 1. Comparing 2007 to 2011 there has been a significant reduction in standard bronchoscopy (P=0.0001), CT guided biopsy of peripheral lesions (P=0.0008) and mediastinoscopy (P=0.0382). The proportion of cases diagnosed by EBUS-TBNA significantly increased from 0% in 2007 to 21.4% in 2009 and 25.4% in 2011 (P<0.0001). There has been a significant increase in the proportion of patients going straight to surgery without pathological confirmation (p=0.002).
Conclusions The use of diagnostic modalities that provide information on diagnosis and staging in a single intervention are increasing. At our hospital, the use of EBUS-TBNA has led to a significant reduction in CT guided biopsies, standard bronchoscopies and mediastinoscopies. These changes in practise have implications for future service provision, training and commissioning.
NICE Lung cancer. 2011.http://publications.nice.org.uk/lung-cancer-cg121/key-priorities-for-implementation.