Implementation of transesophageal ultrasound (EUS-FNA) for lung cancer staging

Abstract

7605 Background: Transesophageal ultrasound-guided fine needle aspiration (EUS-FNA) demonstrated to be an accurate and minimally invasive method for the diagnosis and staging of lung cancer, resulting in a reduced need for surgical staging in around half of patients. Although EUS-FNA is part of lung cancer staging algorithms in recent guidelines, no data exist whether the reported EUS findings—obtained by experts—are reproducible in community hospital settings. Methods: Prospective non-randomized multicenter diagnostic implementation trial. Nine physicians from 5 hospitals participated in a dedicated EUS implementation program including indication assessment and on-site training in 45 patients. Patients with (suspected) non- small cell lung cancer in whom surgical staging of the mediastinum was indicated were eligible. Consecutive patients underwent EUS-FNA in the 5 implementation centers as well as the single expert center. In case of the absence of tissue proven N2/N3 metastases at EUS-FNA, surgical staging or thoracotomy with mediastinal dissection was performed. Primary outcomes were: 1) sensitivity and accuracy regarding mediastinal staging and 2) prevented surgical interventions. Results of implementation centers were compared to that to the expert center. Results: 527 patients were included, 334 (63%) in the implementation and 193 (37%) in the expert center. Sensitivity and accuracy for mediastinal staging (implementation vs expert centers) were 83% and 89% vs 81 and 87% respectively. Surgical staging was spared due to endosonography in 47% (implementation) vs 46% (expert) of patients. Non representative FNA samples were identical (7%) in both groups. One major complication occurred in each group. No differences in the major outcomes were found in the implementation centers comparing results of the first with the second year after introduction of EUS-FNA. Conclusions: Chest physicians without prior (endo)sonography experience obtained the same sensitivity, accuracy and impact on patient management as experts, in performing EUS-FNA for the diagnosis and staging of lung cancer. The proposed implementation program might qualify as a model to facilitate large scale dissemination of EUS-FNA for lung cancer staging. No significant financial relationships to disclose.