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Health Information A Less Invasive Technique for Staging Lung Cancer

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.

Rush is the first hospital in Illinois to offer endobronchial ultrasound, or EBUS, to diagnose lung cancer, lymphomas, infections and other diseases causing enlarged lymph nodes and tumors in the chest.

Lung cancer is the leading cause of cancer death in the United States for both men and women, according to the National Cancer Institute. 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, as well as determine the most appropriate treatment.

All About EBUS
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.

"This is substantially more accurate than all other lung cancer staging methods in use today," says thoracic surgeon Michael Liptay, MD. "The technique takes little time and requires only a mild sedative, and patients go home the same day."

In the past, conventional surgery was required to obtain the diagnostic samples. This surgery, called mediastinoscopy, requires an incision 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," says thoracic surgeon Edward Hong, MD. "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."

A More Accurate Assessment
Published research shows that clinicians were able to find more malignant lymph nodes using EBUS than with 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," says Hong. "In those cases, we have to guess where to take biopsies of the lesions and blindly pass needles through the airway."

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.

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Please note: All physicians featured in Discover Rush Online are on the medical faculty of Rush University Medical Center. Some of the physicians featured are in private practice and, as independent practitioners, are not agents or employees of Rush University Medical Center.

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