Document Detail


Endoscopic ultrasound guided biopsy performed routinely in lung cancer staging spares futile thoracotomies: preliminary results from a randomised clinical trial.
MedLine Citation:
PMID:  16102606     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Soeren S Larsen; Peter Vilmann; Mark Krasnik; Asger Dirksen; Paul Clementsen; Niels Maltbaek; Ulrik Lassen; Birgit G Skov; Grete Krag Jacobsen
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Lung cancer (Amsterdam, Netherlands)     Volume:  49     ISSN:  0169-5002     ISO Abbreviation:  Lung Cancer     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-09-28     Completed Date:  2006-02-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8800805     Medline TA:  Lung Cancer     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  377-85     Citation Subset:  IM    
Affiliation:
Department of Surgical Gasteroenterology, Gentofte University Hospital, Copenhagen, Denmark. ssl@dadlnet.dk
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MeSH Terms
Descriptor/Qualifier:
Aged
Biopsy / methods*
Biopsy, Fine-Needle / methods*
Carcinoma, Non-Small-Cell Lung / diagnosis*,  ultrasonography*
Clinical Trials as Topic
Endoscopy / methods*
Female
Follow-Up Studies
Humans
Lung Neoplasms / diagnosis*,  ultrasonography*
Male
Mediastinoscopy / methods*
Middle Aged
Neoplasm Staging / methods*
Preoperative Care
Random Allocation
Thoracotomy / statistics & numerical data
Time Factors
Treatment Outcome
Ultrasonics

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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