Background and objectives

Endobronchial ultrasound (EBUS) is a relatively new procedure for diagnosis and staging of lung cancer. EBUS is available as EBUS-transbronchial needle aspiration (EBUS-TBNA) for sampling mediastinal lymph nodes and masses and EBUS guide sheath (EBUS-GS) for transbronchial biopsy and brushings of peripheral parenchymal lesions. This study compares the number and type of procedures undertaken to diagnose and stage lung cancer, and the time to management decision (TMD) (time from first presentation at the hospital to establishment of a management decision) before and after the introduction of EBUS at a tertiary hospital in Western Australia.

Methods

Hospital data and medical records of new primary lung cancer cases presenting between January 2007 and December 2008 (Pre-EBUS cohort) and between January 2010 and December 2011 (Post-EBUS cohort) were reviewed.

Results

A total of 560 patients were included in the study: 234 in the Pre-EBUS cohort and 326 in the Post-EBUS cohort. EBUS was performed on 91 patients in the Post-EBUS cohort (EBUS-TBNA for 19.3% of cases and EBUS-GS for 9.5% of cases).  The number of CT- guided fine needle aspirations (CT-FNA) and bronchoscopies decreased following the introduction of EBUS (p=0.015 and p<0.001 respectively).    Logistic regression analysis revealed that greater numbers of imaging events and inpatient and outpatient visits were significant predictors of TMD of >28 days.  Approximately half of patients with an EBUS investigation underwent additional invasive procedures. TMD was significantly longer (45 days for EBUS-GS and 28 days for EBUS-TBNA) for these patients when compared to patients without an EBUS investigation (10 days) and patients who had only an EBUS investigation (8.5 days for EBUS-GS and 10 days for EBUS-TBNA).

Conclusions

The introduction of EBUS led to reduced numbers of CT-FNAs and bronchoscopies and did not impact on TMD. It appears that EBUS was used in diagnostically challenging cases.