Five years of thoracic endoscopy unit activity on lung cancer staging: how teamwork can improve the outcomes

Filippo Tommaso Gallina; Daniela Assisi; Daniele Forcella; Federico Pierconti; Paolo Visca; Enrico Melis; Francesco Facciolo

doi:10.21037/med-20-53

Five years of thoracic endoscopy unit activity on lung cancer staging: how teamwork can improve the outcomes

Mediastinum. 2021 Jun 25:5:13. doi: 10.21037/med-20-53. eCollection 2021.

Authors

Filippo Tommaso Gallina¹, Daniela Assisi², Daniele Forcella¹, Federico Pierconti³, Paolo Visca⁴, Enrico Melis¹, Francesco Facciolo¹

Affiliations

¹ Thoracic Surgery, IRCCS - Regina Elena National Cancer Institute, Rome, Italy.
² Digestive Endoscopy Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy.
³ Anesthesiology and Intensive Care Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy.
⁴ Pathology Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy.

Abstract

Background: Regarding the staging of mediastinal lymph nodes before lung cancer surgery, Endobronchial Ultrasound Transbronchial Needle Aspirations (EBUS-TBNA) have proven to be highly sensitive and specific as well as safe. Endoscopic Ultrasound Fine Needle Aspirations (EUS-FNA) plays an important role in the diagnosis and staging of thoracic diseases, including lung cancer. In this study we analysed all patients underwent endoscopic procedures in our endoscopic mediastinal ultrasound unit.

Methods: Between January 2013 and February 2018, we performed a total of 929 endoscopic procedures, 432 EBUS-TBNA and 497 EUS-FNA. Biopsy was performed at the following mediastinal sites: station 7 in 642 cases, at stations 8 and 9 in 211 cases; at station 3P and 4L in 27 and 114 cases respectively; with EUS we were able to perform biopsy at station 5 in 52 cases.

Results: A total of 841 patients showed a diagnosis of cancer: non-small cell lung cancer (NSCLC) in 645 patients, SCLC in 190 patients, neuroendocrine tumour in 5 patients and one patient with mesothelioma. 88 patients were negative for cancer. In terms of sensitivity, specificity and accuracy, the association between EUS-FNAb and EBUS-TBNAb showed a better quality on diagnosis compared to single procedures. EUS-FNA and EBUS-TBNA are safe, feasible, and highly sensitive techniques.

Conclusions: An endoscopic mediastinal ultrasound unit allows to perform a higher number of endoscopic procedures and improved the sensitivity and the accuracy of the minimally invasive hilar-mediastinal staging.

Keywords: EBUS-TBNAb; EUS-FNAb; Mediastinal lymph nodes; lung cancer; lung cancer staging; thoracic endoscopy.