Implementation of endoscopic ultrasound for lung cancer staging

• Published in: Gastrointestinal endoscopy 2010, Vol.71 (1), p.64-70.e1
• Main Authors: Annema, Jouke T., MD, PhD, Bohoslavsky, Roman, MSc, Burgers, Sjaak, MD, PhD, Smits, Marianne, MD, Taal, Babs, MD, Venmans, Ben, MD, PhD, Nabers, Hans, MD, PhD, van de Borne, Ben, MD, PhD, van Balkom, Roland, MD, PhD, Haitjema, Tjeerd, MD, PhD, Welling, Alle, MD, Staaks, Gerald, MD, Dekkers, Olaf M., MD, PhD, van Tinteren, Harm, MD, PhD, Rabe, Klaus F., MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Biopsy, Fine-Needle; Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - pathology; Endosonography - methods; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Male; Medical sciences; Middle Aged; Neoplasm Staging - methods; Pneumology; Prospective Studies; Tumors of the respiratory system and mediastinum
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2009.07.027

Background EUS-guided FNA is currently advocated in lung cancer staging guidelines as an alternative for surgical staging to prove mediastinal metastases. To date, training requirements for chest physicians to obtain competency in EUS for lung cancer staging are unknown. Objective To test a training and implementation strategy for EUS for the diagnosis and staging of lung cancer. Design Prospective national multicenter implementation trial. Nine (chest) physicians from 5 hospitals participated in a dedicated EUS educational program (investigation of 50 patients) for the diagnosis and staging of lung cancer. EUS outcomes of trainees were compared with those of the training center. Setting Four general hospitals, the national cancer center (implementation centers), and a tertiary referral center (expert center). Patients This study involved 551 consecutive patients with (suspected) lung cancer, all candidates for surgical staging, who underwent EUS in 1 of the 5 implementation centers (n = 346) or the single expert center (n = 205). Surgical-pathological staging was the reference standard in case no mediastinal metastases were found. Results EUS had a sensitivity of 83% versus 82% and accuracy of 89% versus 88% for mediastinal nodal staging (implementation center vs expert center). Surgery was spared because of EUS findings in 51% versus 54% of patients. A single complication occurred in each group. Limitation Surgical-pathological verification of mediastinal nodes was not available in all patients staged negative at EUS. Conclusion Chest physicians who participate in a dedicated training and implementation program for EUS in lung cancer staging can obtain results similar to those of experts for mediastinal nodal staging.