Endosonography can offer a more effective, cheaper and less invasive method of staging lung cancer patients, according to new research published by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme.
Lung cancer is the second most common cancer in the UK and is responsible for more than one in five of all cancer deaths. A vital part of getting the most effective treatment for patients is accurately determining the stage the cancer has reached, by checking if it has spread to lymph nodes in the chest. Current practice uses a surgical procedure called mediastinoscopy to determine the spread of the disease. The operation requires a general anaesthetic and a one to two day stay in hospital.
A research team led by Dr Robert Rintoul at Papworth Hospital NHS Foundation Trust, working with partners in Belgium and the Netherlands has been comparing this standard procedure to less invasive state-of-the-art investigation techniques. The relatively new approach combined the use of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) and endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA). These techniques use ultrasound to examine the mediastinal cavity and a fine needle to take a sample of cells for analysis. They are usually performed under local anaesthetic with sedation, often as an outpatient procedure. A total of 241 lung cancer patients were randomised to receive either the standard surgical procedure alone or the combined endosonography technique. In this study patients undergoing initial examination with endosongraphy were subsequently re-examined using the standard surgical procedure if no signs of cancer were detected. The results showed that, for patients who initially had an examination with endosonograpy and only proceeded to a surgical examination if the endosonography was negative, the detection rate of cancerous cells was 94%. This compared with a rate of 79% where the surgical procedure alone was used. The study also found that the quality of life experienced during the staging period was higher in the group that received the endosongraphy, than in those receiving only the surgical procedure. Finally, examining patients using the initial endosonography approach was found to be more cost-effective.
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