Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) reduces time for diagnosis of lung cancer if used as the initial diagnostic test of choice

Abstract

Introduction: An effective lung cancer pathway is dependent upon use of minimum invasive diagnostic tests to diagnose and stage the disease. We performed a retrospective study to determine whether early use of EBUS reduced time for diagnosis (1). Aims and objectives: We compared the duration required for diagnosis with or without using EBUS as the initial test and whether use of other diagnostic techniques as initial test lead to delays. Methods: This was a retrospective study of patients diagnosed with lung cancer via linear EBUS between January 2013 to 2015. Time to diagnosis was calculated from the day decision was made for initial diagnostic test to the day when final histopathological result was available. Results: A total of 126 patients underwent 168 procedures; 84 had EBUS as initial test, 42 had other tests initially (34 bronchoscopies, 7 CT biopsy and 1 liver biopsy) and subsequently EBUS as final test. The mean age was 70 years and 72 (57%) were males. The initial non-diagnostic tests included 30 bronchoscopies, 4 CT guided lung biopsies and 1 liver biopsy. A review of CT scans of these patients showed mediastinal lymph nodes amenable to EBUS. The mean duration to diagnose lung cancer was 20 days if EBUS was used as the initial test versus 38 days if other modalities were used as initial test. Conclusion: In our study 27% of patients had non-diagnostic results if EBUS was not used as initial test, causing delay in diagnosis. We propose that patients with lesions amenable to EBUS should have EBUS as initial test to reduce delays. Reference: 1. Lung-BOOST trial investigators Lancet Respir Med 2015; 3: 282-89.