Usefulness of a Lung Cancer Rapid Diagnosis Specialist Clinic. Contribution of Ultrasound Bronchoscopy

Sanz-Santos, José; Andreo, Felipe; Sánchez, Dan; Castellá, Eva; Llatjós, Maria; Bechini, Jordi; Guasch, Ignasi; De Castro, Pedro López; Roca, Josep; Parra, Isidre; Monsó, Eduard

doi:10.1016/S1579-2129(10)70139-7

Archivos de Bronconeumología

ISSN: 0300-2896

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Vol. 46. Issue 12.

Pages 640-645 (January 2010)

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Pages 640-645 (January 2010)

Original Article

DOI: 10.1016/S1579-2129(10)70139-7

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Usefulness of a Lung Cancer Rapid Diagnosis Specialist Clinic. Contribution of Ultrasound Bronchoscopy

Utilidad de una consulta monográfica de diagnóstico rápido de cáncer de pulmón. Aportaciones de la ecobroncoscopia

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José Sanz-Santosa,b,

Corresponding author

34057jss@comb.cat

Corresponding author.

, Felipe Andreoa,c, Dan Sáncheza, Eva Castellác,d, Maria Llatjósc,d, Jordi Bechinie, Ignasi Guasche, Pedro López De Castrof, Josep Rocag, Isidre Parrah, Eduard Monsóa,c

a Servicio de Neumología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

b Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain

c Ciber de Enfermedades Respiratorias (CiBeres), Bunyola, Baleares, Spain

d Servicio de Anatomía Patológica, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

e Servicio de Radiodiagnóstico, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

f Servicio de Cirugía Torácica, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

g Servicio de Epidemiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

h Institut Català de la Salut, Barcelona, Spain

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Abstract

Objective

To analyse the results obtained in the diagnosis and staging of lung cancer (LC) by a Lung Cancer Rapid Diagnosis Unit (LC-RDU) in which real-time endobronchial ultrasound-guided transbronchial needle aspiration (RT-EBUS guided-TBNA) is performed as part of the clinical evaluation of the patient prior to treatment.

Method

A four year observational study was conducted on a group of patients evaluated due to suspicion of LC in an LC-RDU. The times and the techniques required for the diagnosis, the treatment period and the level of the disease in the initial staging were recorded.

Results

Out of a total of 678 patients seen in the LC-RDU, the diagnosis in 352 was confirmed in one or more histopathology tests. In 170 patients (48.2%) the diagnosis was made with biopsies and/ or cytology samples obtained by fibrobronchoscopy, and RT-EBUS guided-TBNA confirmed the clinical suspicion in 70 patients (19.9%). In the 280 patients with NSCLC, 166 RT-EBUS guided-TBNA were performed for staging (59.3%), and in 105 of them the technique only showed local disease (37.5%). Eighty-three of these patients underwent therapeutic surgery, which was radical in 73 cases (87.9%).

Conclusion

In half of the patients referred to the LC-RDU due to suspected LC, the diagnosis was confirmed in 75% of cases using endoscopic techniques. RT-EBUS guided-TBNA, which was the diagnostic technique in 20% of the cases and for staging in more than half of them, led to reduced waiting times to diagnosis and onset to treatment.

Keywords:

Lung cancer

Endobronchial ultrasound

Transbronchial needle aspiration

Time to diagnosis

Rapid diagnosis unit

Resumen

Objetivo

Analizar los resultados conseguidos en diagnóstico y estadificación del cáncer de pulmón (CP) por una unidad de diagnóstico rápido de cáncer de tórax (UDR-CT) que incorpora la ultrasonografía endobronquial con punción transbronquial aspirativa en tiempo real (USEB-PTBA-tr) a la evaluación clínica del paciente previa al tratamiento.

Método

Se ha realizado un estudio observacional del conjunto de pacientes valorados por sospecha diagnóstica de CP en una UDR-CT durante cuatro años, registrando los tiempos y la técnica requeridos para el diagnóstico, el tiempo para el tratamiento, y el grado de identificación de enfermedad en estadio inicial.

Resultados

Seiscientos setenta y ocho pacientes fueron atendidos en la UDR-CT, en 352 casos el diagnóstico fue confirmado en una o más muestras anatomopatológicas. En 170 pacientes el diagnóstico se obtuvo con biopsias y/o citologías obtenidas por fibrobroncoscopia (48,2%), la USEB-TTBA-rt confirmó la sospecha clínica en 70 pacientes (19,9%). En 280 pacientes afectos de carcinoma de pulmón no célula pequeña (CPNCP) se practicaron 166 USEB-PRBA-tr de estadificación (59,3%) y en 105 de ellos la técnica mostró únicamente enfermedad local (37,5%). En 83 de estos pacientes se procedió a cirugía terapéutica, que fue radical en 73 casos (87,9%).

Conclusión

En la mitad de pacientes remitidos a la UDR-CT por sospecha de CP el diagnóstico se confirma, por técnicas endoscópicas en tres cuartas partes de los casos. La USEB-TTBA-rt es la técnica diagnóstica en una quinta parte de los casos y de estadificación en más de la mitad de ellos, y permite reducir los tiempos de espera hasta el diagnóstico y el inicio de tratamiento.

Palabras clave:

Cáncer de pulmón

Ultrasonografía endobronquial

Punción transbronquial aspirativa

Tiempo para diagnóstico

Unidad de diagnóstico rápido

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