TUESDAY, Aug. 23, 2005 (HealthDay News) -- A new technique for taking tiny tissue samples from the chest reduces unwarranted surgery for people suffering with advanced lung cancer, Dutch surgeons report.
The method goes under the cumbersome name of transesophageal ultrasound-guided fine needle aspiration -- abbreviated EUS-FNA. And a study of 107 lung cancer patients showed that, when used in combination with another diagnostic technique, EUS-FNA identified cases in which surgery was unnecessary.
The findings appear in the Aug. 24-31 issue of the Journal of the American Medical Association.
All the patients had non-small cell lung cancer, which is found in 80 percent of cases; it's the type of cancer that killed news broadcaster Peter Jennings earlier this month, said Dr. Robert J. Cerfolio, chief of thoracic surgery at the University of Alabama, Birmingham.
The issue in all these cases is the "stage" of the disease -- the extent to which it has spread. Staging determines whether and what kind of surgery should be done. Jennings had stage 4 cancer, the most advanced form, and was not operated on, Cerfolio said.
The report by surgeons at Leiden University Medical Center said EUS-FNA was used in combination with mediastinoscopy, an examination of the middle of the chest cavity with a specialized scope. The researchers said the combination of the two techniques identified more patients in whom the cancer had spread widely (and thus for whom surgery was not recommended) than either technique alone -- 36 percent with the combination compared to 28 percent with UES-FNA and 20 percent with mediastinoscopy.
Overall, this meant that 16 percent of thoracotomies -- invasive surgeries involving the opening of the chest wall -- could have been avoided using the dual-detection technique, the researchers conclude.
"We have routinely incorporated EUS-FNA in the diagnosis and staging of lung cancer in our hospital," said Dr. Jouke Annema, professor of surgery at Leiden and lead author of the report.
The Leiden physicians are continuing their studies of the technique, he said. "Another study in 242 patients demonstrates that EUS-FNA can prevent 70 percent of scheduled surgical procedures (mainly mediastinoscopies) in patients with suspected lung cancer," Annema said.
The Leiden study is one of a number showing the value of EUS-FNA, said Cerfolio, an expert in the method.
"This technique is very, very vital in the staging of patients with non-small cell lung cancer," Cerfolio said. "It allows you to get to all the lymph nodes." Lymph nodes are small cell-collecting organs that are routinely examined to determine whether cancer has spread.
"There is no question that it reduces unnecessary surgery," he said. "It enables us to stage cancers better, and the better we stage them, the better we treat."
When lung cancer is suspected, the usual procedure is to perform scans such as computerized automated tomography to help identify the lymph nodes that might have cancer in them, Cerfolio said. Until recently, the way to test those lymph nodes would have been to open the chest surgically. Advanced technology such as EUS-FNA has eliminated that surgery in a large number of cases, he said.
"This has changed the treatment of lung cancer across the world, and yet few have it," Cerfolio said. Fewer than 5 percent of U.S. hospitals are equipped for EUS-FNA, he said.
The National Cancer Institute offers more on lung cancer treatments.