Endoscopic ultrasound guided biopsy performed routinely in lung cancer staging spares futile thoracotomies: preliminary results from a randomised clinical trial

TY - JOUR

T1 - Endoscopic ultrasound guided biopsy performed routinely in lung cancer staging spares futile thoracotomies

T2 - preliminary results from a randomised clinical trial

AU - Larsen, Soeren S

AU - Vilmann, Peter

AU - Krasnik, Mark

AU - Dirksen, Asger

AU - Clementsen, Paul

AU - Maltbaek, Niels

AU - Lassen, Ulrik

AU - Skov, Birgit G

AU - Jacobsen, Grete Krag

PY - 2005/9

Y1 - 2005/9

N2 - BACKGROUND: Up to 45% of operations with curative intent for non-small-cell lung cancer (NSCLC) can be regarded as futile, apparently because the stage of the disease is more advanced than expected preoperatively. During the past decade several studies have evaluated the usefulness of endoscopic ultrasound guided fine needle aspiration biopsy (EUS-FNA) in lung cancer staging with promising results. However, no randomised trials have been performed, in which a staging strategy with EUS-FNA performed in all patients is compared with a conventional workup.METHODS: Before surgery (i.e. mediastinoscopy and subsequent thoracotomy) 104 patients from one hospital were randomly assigned to either a conventional workup (CWU), including EUS-FNA only for selected patients, or a strategy where all patients were offered EUS-FNA (routine EUS-FNA) in addition to CWU. Patients were followed up for a median period of 1.3 years (range 0.2-2.4 years). Thoracotomy was regarded as futile if the patient had an explorative thoracotomy without tumour resection or if a resected patient had recurrent disease or died from lung cancer during follow-up. Analysis was by intention to treat.RESULTS: Fifty-three patients were randomly assigned to routine EUS-FNA and 51 patients to CWU. EUS-FNA was performed in 50 patients (94%) in the routine EUS-FNA group and in 14 patients (27%) in the CWU group. In the routine EUS-FNA group five patients (9%) had a futile thoracotomy, compared with 13 (25%) in the CWU group, p = 0.03.CONCLUSION: Addition of routine-EUS-FNA to standard workup in routine clinical practice improved selection of surgically curable patients with NSCLC.

AB - BACKGROUND: Up to 45% of operations with curative intent for non-small-cell lung cancer (NSCLC) can be regarded as futile, apparently because the stage of the disease is more advanced than expected preoperatively. During the past decade several studies have evaluated the usefulness of endoscopic ultrasound guided fine needle aspiration biopsy (EUS-FNA) in lung cancer staging with promising results. However, no randomised trials have been performed, in which a staging strategy with EUS-FNA performed in all patients is compared with a conventional workup.METHODS: Before surgery (i.e. mediastinoscopy and subsequent thoracotomy) 104 patients from one hospital were randomly assigned to either a conventional workup (CWU), including EUS-FNA only for selected patients, or a strategy where all patients were offered EUS-FNA (routine EUS-FNA) in addition to CWU. Patients were followed up for a median period of 1.3 years (range 0.2-2.4 years). Thoracotomy was regarded as futile if the patient had an explorative thoracotomy without tumour resection or if a resected patient had recurrent disease or died from lung cancer during follow-up. Analysis was by intention to treat.RESULTS: Fifty-three patients were randomly assigned to routine EUS-FNA and 51 patients to CWU. EUS-FNA was performed in 50 patients (94%) in the routine EUS-FNA group and in 14 patients (27%) in the CWU group. In the routine EUS-FNA group five patients (9%) had a futile thoracotomy, compared with 13 (25%) in the CWU group, p = 0.03.CONCLUSION: Addition of routine-EUS-FNA to standard workup in routine clinical practice improved selection of surgically curable patients with NSCLC.

KW - Aged

KW - Biopsy

KW - Biopsy, Fine-Needle

KW - Carcinoma, Non-Small-Cell Lung

KW - Clinical Trials as Topic

KW - Endoscopy

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Lung Neoplasms

KW - Male

KW - Mediastinoscopy

KW - Middle Aged

KW - Neoplasm Staging

KW - Preoperative Care

KW - Random Allocation

KW - Thoracotomy

KW - Time Factors

KW - Treatment Outcome

KW - Ultrasonics

KW - Journal Article

KW - Randomized Controlled Trial

U2 - 10.1016/j.lungcan.2005.04.005

DO - 10.1016/j.lungcan.2005.04.005

M3 - Journal article

C2 - 16102606

SN - 0169-5002

VL - 49

SP - 377

EP - 385

JO - Lung Cancer

JF - Lung Cancer

IS - 3

ER -