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Less invasive methods may provide accurate means to determine lung cancer stage
Date:2/5/2008

An evaluation of several endoscopic biopsy methods suggests that a minimally invasive approach may accurately determine the stage of suspected lung cancer, according to a study in the February 6 issue of JAMA.

Lung cancer is the most common cancer-related cause of death in the United States. Determining the stage of the disease is a critical factor regarding therapy and prognosis, according to background information in the article.

Noninvasive staging with chest computed tomography (CT) or positron emission tomography (PET) is associated with high rates of false-positive and false-negative results, respectively. The American College of Chest Physicians recommends invasive staging with tissue confirmation of suspected metastatic mediastinal [center part of the thoracic cavity] lymph nodes. Mediastinoscopy or thoracoscopy [a surgical procedure that requires incisions] has been the diagnostic standard, but less invasive methods have emerged as potential alternatives, the authors write.

Such methods include blind transbronchial needle aspiration (TBNA), endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), and, more recently, endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA).

Michael B. Wallace, M.D., M.P.H., of Mayo Clinic, Jacksonville, Fla., and colleagues compared the diagnostic accuracy of these three methods (and their combinations). Among 138 patients with suspected lung cancer who met all study criteria, 42 (30 percent) had malignant lymph nodes.

The researchers found that EBUS-FNA had higher sensitivity than TBNA (69 percent vs. 36 percent), detecting 29 (vs. 15) of the 42 malignant lymph nodes. EUS plus EBUS had higher estimated sensitivity (93 percent [39/42]) than any of the other methods. Compared with either EUS-FNA or EBUS-FNA alone, the combination identified 10 more malignant lymph nodes, with sensitivity estimated to be 24 percent higher than either approach alone.


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Contact: Paul Scotti
904-953-0199
JAMA and Archives Journals
Source:Eurekalert

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