Is there a need for staging EBUS?
No Thumbnail Available
Authors
Aujayeb, Avinash
Weatherhead, Mark
Hashim, M.
Issue Date
2021
Type
Language
Keywords
Alternative Title
Abstract
Introduction: Nodal sampling via (EBUS) is well established in the lung cancer pathway. A staging EBUS involves targeted mediastinal and hilar lymph nodal sampling via a systematic approach of any lymph node greater than 5 mm in maximum dimension and of smaller nodes which might be FDG-avid on PET-CT.
There is a growing movement nationally that all patients with N1 or central disease on CT or PET-CT should undergo a staging EBUS before resection due to a concern about upstaging in this patient group but this has resource implications.
Methods: We performed a retrospective review of all patients between January 2014 and December 2018 who had undergone surgical resection. We analysed their TNM stage based on CT/PET-CT and reviewed if their nodal stage had changed following surgery and if staging EBUS would have changed the pre-operative stage and management.
Results: 189 patients had surgical resection. 48 had central disease or N1 disease on PET/CT pre-operative staging.
5 of those had an EBUS based on clinical concerns and there was no upstaging either at EBUS or at resection.
No multi-station N2 or N3 disease was detected in the resection group.
4 patients in this group were found to have single station N2 disease at resection.
2 patients had positive station 8/9 nodes that would not have been detected at EBUS
2 patients had positive station 7 nodes at resection.
One patient was alive 3 years later with no disease evident (patient was given adjuvant chemo)- pre-op stage was T3N1M0, post-op stage was T2bN2M0.
The 2nd patient was alive 1 year later with no disease evident (also given adjuvant chemo)- pre-op stage T2N1M0- post T2bN2M0.
Conclusion: Our local single trust experience suggests that routine use of staging EBUS would have added no extra benefit to our patients over standard practice of clinicoradiological correlation by an MDT team and focused use of staging investigations.
Staging EBUS in all these patients would have meant 43 extra EBUS over 5 years with the potential pick-up of 2 single station N2 disease but leading to NO alteration of management in any patients.
This approach would have significant cost and resource implications as EBUS costs approximately £1200- £2000. Therefore, the cost to health economy would been approximately £50K-£80K over 5 years in single centre.
Description
Citation
Hashim, M., Aujayeb, A. and Weatherhead, M. (2021) P220?Is there a need for staging EBUS? Thorax; 76 : A208-A209.
Publisher
Thorax
License
Journal
Volume
Issue
PubMed ID
ISSN
1468-3296