Use of a minimally invasive technique called endoscopy to detect lung cancer may be more effective than more complicated and invasive standard procedures. These findings were recently published in the Journal of the American Medical Association.

Lung cancer is the most common cancer worldwide. There are three types of lung cancer: non–small cell, small cell, and mesothelioma. Non–small cell and small cell lung cancers are the most common types of lung cancer, whereas mesothelioma is a rare form of lung cancer that attacks the lining of the lung tissue. Unfortunately, survival rates for lung cancer are low because the disease is often found once it has spread within the lung or to other organs. In an attempt to improve patient outcomes, a great deal of research has focused on lung cancer screening, diagnosis, and treatment.

Physicians may use several different techniques to diagnose lung cancer and determine to what extent the disease may have spread. Techniques may include a physical exam, chest X-rays, CT scans of the chest, as well as more invasive tests to examine the cells in the lungs and lymph nodes.

In many cases collecting cell samples from the lungs or lymph nodes requires the patient to be anesthetized while the surgeon removes fluid or tissue samples. The standard approach is called a mediastinoscopy, in which a surgeon inserts a thin, lighted tube through an incision made at the top of the breast bone. This allows the surgeon to view the inside of the chest, as well as remove tissue samples from the lung and lymph nodes.

More recently, less invasive procedures have been developed to examine the chest and collect tissue samples. These procedures are performed by endoscopy, which utilizes a medical device (an endoscope) consisting of a camera mounted on a flexible tube. Small needles or instruments can be passed through the tube to remove samples for biopsy. Ultrasound probes can also be used with the endoscope to help guide removal of suspicious tissues or fluid.

In this recent study, researchers compared the following three minimally invasive procedures using an endoscope:

  • Traditional transbronchial needle aspiration (TBNA)
  • Endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA)
  • Transesophageal endoscopic ultrasound-guided fine needle biopsy (EUS-FNA)

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In each of these procedures, an endoscope was used either with or without the use of ultrasound to remove tissues or fluid with a small, fine needle. Direct comparisons were made between the findings of EBUS-FNA, TBNA,and EUS-FNA and EBUS-FNA used in combinationto determine which approach was the most sensitive for detecting the presence of cancerous cells within lymph nodes of the chest. Sensitivity is defined as the ability to detect cancerous cells when they are present in the lymph nodes.

Researchers conducted the study among 138 patients in the United States who were suspected of having lung cancer. Each patient underwent all three procedures sequentially as a single combined procedure.

  • Results of the study revealed that 42 (30%) of the patients had malignant lymph nodes.
  • EBUS-FNA was found to be more sensitive for detecting the cancer cells than TBNA, detecting 29 (69%) malignant lymph nodes, while TBNA only detected 15 (36%).
  • In combination, EUS-FNA and EBUS-FNA had an even greater sensitivity rate of 93%, which was better than either method used alone. This combination was also able to accurately detect malignant lymph nodes among patients who did not have enlarged lymph nodes that could be detected by CT scans of the chest.

These findings suggest that the combination of EBUS-FNA and EUS-FNA was superior to TBNA. These minimally invasive procedures may allow for accurate diagnosis and evaluation of patients with suspected lung cancer. These results will need to be confirmed in other studies, but suggest that this combined approach of endoscopic methods may be a viable alternative to invasive standard procedures for evaluating patients suspected of having lung cancer.

Reference: Wallace, M, Pascual, J, Raimondo, M, et al. Minimally invasive endoscopic staging of suspected lung cancer. Journal of American Medical Association. 2008. 299(5) 540-546.

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