Impact of EUS-FNA on Patient Management, Resource Use, and Clinical Outcomes in Patients With Lung Cancer

Abstract

Introduction: Lung cancer is the most common cause of cancer death in the United States. The initial management is to confirm the diagnosis and to assess the stage of the disease. Unfortunately, about half of the patients at the time of the presentation have mediastinal lymph node involvement. Computed tomography (CT) scanning remains the initial method in staging of patient with suspected lung cancer, but it has limited sensitivity and specificity for detecting nodal involvement. EUS has been increasingly recognized as a valuable tool for mediastinal staging lung cancer. If EUS is not available the alternative is mediastinoscopy. The purpose of this paper is to study the impact of EUS on patient management, resource use, and clinical outcomes in patients with suspected lung cancer. Methods: We studied 64 consecutive patients with suspected lung cancer who underwent EUS-FNA for lung staging or diagnosis in a retrospective study from 2003 to 2014. In 52 patients Olympus echo endoscope was used, while in 12 patients Pentax echo endoscope was used. FNA was performed using 22 g needle in 32 patients, 25 g needle in 13 patients and 19 g needle in 8 patients. A 25 g pro-core needle was used in 11 patients. Patients found to have operable disease underwent thoracotomy. We assumed that in the absence of EUS, patients with operable disease on CT will undergo thoracotomy. If suspicious lymph node were noted on computed tomography (CT), mediastinoscopy will be performed in the absence of EUS. Results: Final diagnosis was available for each patient (lung cancer n= 40, lymphoma n=8, benign n=9, cyst n=5). Benign included 5 sarcoidosis, 2 reactive lymphadenopathy and 2 TB. Clinical management was altered due to the results from EUS-FNA in 48 of 64 patients, these include 35 patients with lung cancer, 8 with lymphoma, and 5 with a benign biopsy. EUS-FNA ($1,614) was less expensive than mediastinoscopy ($2,548). In 26 patients, an unnecessary thoracotomy was avoided. No complications were observed in EUS-FNA group of patients. Conclusion: The use of EUS-FNA for mediastinal staging of suspected lung cancer appears to be a safe and cost-effective approach. In our study, EUS-FNA changed clinical management in most patients by avoiding unnecessary thoracotomy or mediastinoscopy, reducing hospital stay, and improving patient outcomes. The introduction of EBUS should supplant the use of EUS-FNA, making mediastinoscopy unnecessary in the staging of lung cancer.