Endobronchial ultrasound: More precise and less invasive than other lung cancer staging methods

A new technique being used by thoracic surgeons at Rush University Medical Center offers a more precise, less invasive and more versatile way of assessing a patient's lymph nodes and chest tumors to determine if lung cancer has spread to other parts of the body.

The procedure is called endobronchial ultrasound or EBUS, and Rush is the first hospital in Illinois offering the minimally invasive system to diagnose lung cancer, lymphomas, infections and other diseases causing enlarged lymph nodes and tumors in the chest.

"This is substantially more accurate than all other lung cancer staging methods in use today," said Dr. Michael Liptay, chief of thoracic surgery at Rush University Medical Center. "The technique takes little time, requires only a mild sedative and patients go home the same day."

EBUS uses a small flexible tube to access lymph nodes that is placed into the trachea, or airway, or into the esophagus to reach nodes or tumors at the front and sides. A special endoscope fitted with an ultrasound processor and a fine-gauge aspiration needle is gently guided through the patient's trachea. Physicians then perform a technique known as a transbronchial needle aspiration to obtain tissue and fluid samples from the lungs and surrounding lymph nodes.

In the past, conventional surgery was required to obtain the diagnostic samples. This surgery, called mediatinoscopy, requires an incision is made in the neck just above the breastbone. Then, a rigid steel scope called a mediastinoscope is inserted through the opening to provide access to chest tumors and lymph nodes.

In contrast, use of EBUS does not require an incision and doctors can perform needle aspiration using a bronchoscope inserted through the mouth.

"Not only are we able to provide patients with a one-time procedure that has a faster recovery time, but EBUS also allows us to display real-time, improved images of the surface of the airways, blood vessels, lungs and lymph nodes, said Dr. Edward Hong, thoracic surgeon at Rush. "This gives us the ability to easily view difficult-to-reach areas and to access more, and smaller lymph nodes and tumors for biopsy compared to conventional surgery."

Published research shows that clinicians were able to find more malignant lymph nodes using EBUS than with the use of a conventional endoscope.

"In some patients, cancerous lesions may be located outside the bronchial tube, and the standard bronchoscopy techniques do not reveal their locations," said Hong. "In those cases, we have to guess where to take biopsies of the lesions and blindly pass needles through the airway."

"This new technique increases our ability to diagnose the patient's condition, helps us give patients all of their possible treatment options and may decrease the need for other surgical procedures," said Liptay.

In addition, the accuracy and speed of the EBUS procedure lends itself to rapid onsite pathologic evaluation. Pathologists in the operating room can process and examine the biopsy samples as they are obtained, and can request additional samples to be taken immediately if needed. Since thoracic surgeons at Rush are conducting the procedure, if immediate surgery is necessary, they can perform the procedure under the same anesthetic instead of making the patient undergo multiple procedures.

Lung cancer is the most common cause of cancer death. Treatment of the disease depends on whether the cancer has spread outside of the lungs, and in order to know that, physicians need to biopsy or remove a small piece of tissue for examination from the lymph nodes that are adjacent to the organ. Patients whose cancer has not spread can be treated with potentially curative surgery to remove lung tumors, and chemotherapy and radiation are used for patients whose cancer has spread. Staging cancer is the process by which doctors determine whether a cancer has spread to other sites such as the lymph nodes or other organs and also to determine the most appropriate treatment.

Souce: Rush University Medical Center