Five years of thoracic endoscopy unit activity on lung cancer staging: how teamwork can improve the outcomes

Our plain-English summary of Five years of thoracic endoscopy unit activity on lung cancer staging: how teamwork can improve the outcomes, by F.T. Gallina, D. Assisi, D. Forcella, et al (Mediastinum, 2021).

The study

• Authors: F.T. Gallina, D. Assisi, D. Forcella, F. Pierconti, P. Visca, E. Melis, F. Facciolo
• Journal: Mediastinum
• Published: 2021;5:13
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Regarding the staging of mediastinal lymph nodes before lung cancer surgery, Endobronchial Ultrasound Transbronchial Needle Aspirations (EBUS-TBNA) have proven to be highly sensitive and specific as well as safe. Endoscopic Ultrasound Fine Needle Aspirations (EUS-FNA) plays an important role in the diagnosis and staging of thoracic diseases, including lung cancer. In this study we analysed all patients underwent endoscopic procedures in our endoscopic mediastinal ultrasound unit.

Methods: Between January 2013 and February 2018, we performed a total of 929 endoscopic procedures, 432 EBUS-TBNA and 497 EUS-FNA. Biopsy was performed at the following mediastinal sites: station 7 in 642 cases, at stations 8 and 9 in 211 cases; at station 3P and 4L in 27 and 114 cases respectively; with EUS we were able to perform biopsy at station 5 in 52 cases.

Results: A total of 841 patients showed a diagnosis of cancer: non-small cell lung cancer (NSCLC) in 645 patients, SCLC in 190 patients, neuroendocrine tumour in 5 patients and one patient with mesothelioma. 88 patients were negative for cancer. In terms of sensitivity, specificity and accuracy, the association between EUS-FNAb and EBUS-TBNAb showed a better quality on diagnosis compared to single procedures. EUS-FNA and EBUS-TBNA are safe, feasible, and highly sensitive techniques.

Conclusions: An endoscopic mediastinal ultrasound unit allows to perform a higher number of endoscopic procedures and improved the sensitivity and the accuracy of the minimally invasive hilar-mediastinal staging.

2021 Mediastinum. All rights reserved.

In plain English

This retrospective review from a cancer centre in Rome, Italy, did not examine asbestos exposure. It assessed two needle biopsies of chest lymph nodes, EUS-FNA through the oesophagus and EBUS-TBNA through the airway, in patients with suspected mediastinal malignancies, for lung cancer staging. From January 2013 to February 2018, 929 procedures were done (497 EUS-FNA, 432 EBUS-TBNA). Diagnoses included non-small cell lung cancer (645), small cell lung cancer (190), neuroendocrine tumour (5) and mesothelioma, type not stated (1). In 88 cases the biopsy found no tumour cells. In 36 of these the samples were inadequate, and surgery then found non-small cell lung cancer in 12 and small cell in 14. Accuracy was 93.5% for EUS-FNA, 91% for EBUS-TBNA and 96% for both combined. The authors reported the combined accuracy as significantly higher than either method alone. The comparison of waiting times covered 798 patients followed there throughout. In this group, time from first visit to treatment was significantly shorter in 2016 to 2017 than in 2013 to 2015 (24.5 versus 29.5 days). The authors concluded that the team-based unit increased procedure numbers and improved staging sensitivity and accuracy.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: retrospective review of diagnostic performance at a single centre
• Who was studied: Patients with suspected mediastinal malignancies discussed in the thoracic endoscopy unit of the Regina Elena National Cancer Institute, Rome, Italy, January 2013 to February 2018; 929 endoscopic procedures (432 EBUS-TBNA, 497 EUS-FNA)
• Main results:
  • 929 endoscopic procedures were performed between January 2013 and February 2018: 432 EBUS-TBNA and 497 EUS-FNA
  • Final diagnoses: non-small cell lung cancer in 645 (76.69%), small cell lung cancer in 190 (22.59%), neuroendocrine tumour in 5 (0.60%) and mesothelioma in 1 (0.12%); the mesothelioma site was not specified
  • 88 cases had negative endoscopic diagnoses (no tumour cells). In 36 of these the specimens were inadequate, and surgery then gave a final diagnosis of non-small cell lung cancer in 12, small cell lung cancer in 14 and no tumour cells in 10
  • EUS-FNA biopsies: sensitivity 95.5%, specificity 97%, accuracy 93.5%
  • EBUS-TBNA biopsies: sensitivity 92.5%, specificity 96.3%, accuracy 91%
  • Combined EBUS-TBNA and EUS-FNA: sensitivity 97.0%, specificity 100%, accuracy 96%. Combined accuracy was reported as significantly higher than either single method (P less than 0.05)
  • At station 7, EUS-FNA had higher accuracy than EBUS-TBNA, but the difference was not significant. At station 4L, EBUS-TBNA was higher, also not significantly
  • Procedure numbers and overall accuracy improved over the five years, especially in 2016 to 2017
  • Among the 798 patients followed at the institution from first visit to definitive treatment, time to treatment was significantly lower in 2016 to 2017 than in 2013 to 2015 (24.5 plus or minus 6 vs 29.5 plus or minus 7 days; P less than 0.05)
• The authors' conclusion: The authors concluded that setting up a thoracic endoscopy unit, with both procedures done by digestive endoscopists and thoracic surgeons, increased the number of procedures and improved the sensitivity and accuracy of minimally invasive hilar-mediastinal staging

Topics

Medical terms in this study, explained in our Lexicon: Endoscopy, Lung Cancer, Staging, Mediastinal Lymph Nodes, Ultrasound, Biopsy, Non-Small Cell Lung Cancer, Mesothelioma.

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