Lung cancer diagnosis and staging with endobronchial ultrasound-guided transbronchial needle aspiration compared with conventional approaches: an open-label, pragmatic, randomised controlled trial.

By:

Navani, N

Contributor(s):

Publication details: 2015ISSN:

22132600

Uniform titles:

The Lancet Respiratory Medicine

Online resources:

Click here to access online

Summary: <h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif; line-height: 17.9998016357422px;">BACKGROUND:</h4>The diagnosis and staging of lung cancer is an important process that identifies treatment options and guides disease prognosis. We aimed to assess endobronchial ultrasound-guided transbronchial needle aspiration as an initial investigation technique for patients with suspectedlung cancer.<h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif; line-height: 17.9998016357422px;">METHODS:</h4>In this open-label, multicentre, pragmatic, randomised controlled trial, we recruited patients who had undergone a CT scan and had suspected stage I to IIIA lung cancer, from six UK centres and randomly assigned them to either endobronchial ultrasound-guided transbronchialneedle aspiration (EBUS-TBNA) or conventional diagnosis and staging (CDS), for further investigation and staging. If a target node could not be accessed by EBUS-TBNA, then endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was allowed as an alternative procedure. Randomisation was stratified according to the presence of mediastinal lymph nodes measuring 1 cm or more in the short axis and by recruiting centre. We used a telephone randomisation method with permuted blocks of four generated by a computer. Because of the nature of the intervention, masking of participants and consenting investigators was not possible. The primary endpoint was the time-to-treatment decision after completion of the diagnostic and staging investigations and analysis was by intention-to-diagnose. This trial is registered with ClinicalTrials.gov, number<a href="http://clinicaltrials.gov/show/NCT00652769" title="See in ClincalTrials.gov" style="border-bottom-width: 0px;">NCT00652769</a>.<h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif; line-height: 17.9998016357422px;">FINDINGS:</h4>Between June 10, 2008, and July 4, 2011, we randomly allocated 133 patients to treatment: 66 to EBUS-TBNA and 67 to CDS (one later withdrew consent). Two patients from the EBUS-TBNA group underwent EUS-FNA. The median time to treatment decision was shorter with EBUS-TBNA (14 days; 95% CI 14-15) than with CDS (29 days; 23-35) resulting in a hazard ratio of 1·98, (1·39-2·82, p<0·0001). One patient in each group had a pneumothorax from a CT-guided biopsy sample; the patient from the CDS group needed intercostal drainage and was admitted to hospital.<h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif; line-height: 17.9998016357422px;">INTERPRETATION:</h4>Transbronchial needle aspiration guided by endobronchial ultrasound should be considered as the initial investigation for patients with suspected lung cancer, because it reduces the time to treatment decision compared with conventional diagnosis and stagingtechniques.

Holdings
Item type	Home library	Collection	Class number	Status	Date due	Barcode
UNKNOWN	Ferriman information and Library Service (North Middlesex) Online	Staff publications for NMDX		Available

NMUH Staff Publications

<h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif; line-height: 17.9998016357422px;">BACKGROUND:</h4>The&nbsp;diagnosis&nbsp;and&nbsp;staging&nbsp;of&nbsp;lung&nbsp;cancer&nbsp;is an important process that identifies treatment options and guides disease prognosis. We aimed to assess&nbsp;endobronchial&nbsp;ultrasound-guided&nbsp;transbronchial&nbsp;needle&nbsp;aspiration&nbsp;as an initial investigation technique for patients with suspectedlung&nbsp;cancer.<h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif; line-height: 17.9998016357422px;">METHODS:</h4>In this&nbsp;open-label, multicentre,&nbsp;pragmatic,&nbsp;randomised&nbsp;controlled&nbsp;trial, we recruited patients who had undergone a CT scan and had suspected stage I to IIIA&nbsp;lung&nbsp;cancer, from six UK centres and randomly assigned them to either&nbsp;endobronchial&nbsp;ultrasound-guided&nbsp;transbronchialneedle&nbsp;aspiration&nbsp;(EBUS-TBNA) or&nbsp;conventional&nbsp;diagnosis&nbsp;and&nbsp;staging&nbsp;(CDS), for further investigation and&nbsp;staging. If a target node could not be accessed by EBUS-TBNA, then endoscopic&nbsp;ultrasound-guided&nbsp;fine&nbsp;needle&nbsp;aspiration&nbsp;(EUS-FNA) was allowed as an alternative procedure. Randomisation was stratified according to the presence of mediastinal lymph nodes measuring 1 cm or more in the short axis and by recruiting centre. We used a telephone randomisation method with permuted blocks of four generated by a computer. Because of the nature of the intervention, masking of participants and consenting investigators was not possible. The primary endpoint was the time-to-treatment decision after completion of the diagnostic and&nbsp;staging&nbsp;investigations and analysis was by intention-to-diagnose. This&nbsp;trial&nbsp;is registered with ClinicalTrials.gov, number<a href="http://clinicaltrials.gov/show/NCT00652769" title="See in ClincalTrials.gov" style="border-bottom-width: 0px;">NCT00652769</a>.<h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif; line-height: 17.9998016357422px;">FINDINGS:</h4>Between June 10, 2008, and July 4, 2011, we randomly allocated 133 patients to treatment: 66 to EBUS-TBNA and 67 to CDS (one later withdrew consent). Two patients from the EBUS-TBNA group underwent EUS-FNA. The median time to treatment decision was shorter with EBUS-TBNA (14 days; 95% CI 14-15) than with CDS (29 days; 23-35) resulting in a hazard ratio of 1·98, (1·39-2·82, p&lt;0·0001). One patient in each group had a pneumothorax from a CT-guided biopsy sample; the patient from the CDS group needed intercostal drainage and was admitted to hospital.<h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif; line-height: 17.9998016357422px;">INTERPRETATION:</h4>Transbronchial&nbsp;needle&nbsp;aspiration&nbsp;guided by&nbsp;endobronchial&nbsp;ultrasound should be considered as the initial investigation for patients with suspected&nbsp;lung&nbsp;cancer, because it reduces the time to treatment decision&nbsp;compared&nbsp;with&nbsp;conventional&nbsp;diagnosis&nbsp;and&nbsp;stagingtechniques.

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