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New EBUS Technique May Improve Lung Cancer Treatment

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UW Health Offers Innovation in Diagnosis

Endobronchial Ultrasound (EBUS) tip with balloon and working channel for EBUS-guided FNA

Endobronchial Ultrasound (EBUS) tip with balloon and working channel for EBUS-guided FNA

MADISON - Based on rates from 2002-2004, one in 14 men and women in the United States will be diagnosed with cancer of the lung and bronchus during their lifetime. Diagnosing that cancer in its earliest stages, before it has spread from its primary site, makes a significant difference to the range of treatment options as well as survival rates.

An emerging diagnostic innovation – Endobronchial Ultrasound, or EBUS – is giving physicians a new, minimally-invasive tool to more accurately stage lung cancer.
 
"This is really changing how we practice," says UW Health surgeon Tracey Weigel, MD, a member of the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center and co-director of the Multi-Disciplinary Lung Cancer Clinic. "It's just better care. There can be just so many uncertainties with radiologic staging, and you don't want to put people through a big operation if it will not help them."

UW Hospital is one of only a few hospitals in Wisconsin to use EBUS, a hybrid of ultrasound guidance with bronchoscope visualization that enables real-time transbronchial needle aspiration to be performed. This combination aids in the diagnosis and staging of lung cancer.

The Endobronchial Ultrasound (EBUS) Procedure
 
Tracey Weigel, MD

Tracey Weigel, MD

In an endobronchial ultrasound, the patient is placed under conscious sedation or general anesthesia and a small bronchoscope is passed through the mouth down into the patient’s trachea. The scope has a transducer at its tip, which can be pointed in different directions to produce images of lymph nodes and other structures in the mediastinum and lung parenchyma.

If suspicious areas are seen – such as enlarged lymph nodes - physicians pass a hollow needle guided by real-time ultrasound through the bronchoscope into the abnormal structures to obtain a biopsy, avoiding the incisions of more invasive procedures such as mediastinoscopy, thoracoscopy or thoracotomy. The procedure is usually completed in less than half an hour.

"It's really a well-designed system," Dr. Weigel says. "In most instances, it offers better sensitivity and specificity without having to make an incision."

Endobronchial Ultrasound and Accurate Lung Cancer Staging
 
As lung cancer is typically diagnosed after it has already spread, EBUS's ability to accurately stage cancer may allow patients with early-stage lung cancer to undergo less invasive surgery such as a video-assisted thoracoscopic (VATS) lobectomy. With less-invasive procedures, such patients may then leave the hospital sooner and use less pain medication as they recover.

"The greatest advantage of this technology is that people will not receive more aggressive surgery or chemotherapy than they need - or less than they need - because of the improved accuracy of EBUS when used in conjunction with conventional staging with CT and PET scans," Dr. Weigel says.

James Maloney, MD

James Maloney, MD

Dr. Weigel and her colleague, James Maloney, MD, have performed more than 50 EBUS procedures at UW Hospital. She tells the story of one patient with a PET scan showing potentially locoregionally advanced lung cancer presumed to be stage III – involving the lymph nodes near the trachea.
 
The patient was scheduled for EBUS and possible surgery to remove a tumor in the right upper lobe of her lung, if the mediastinal nodes were not involved. At the time of surgery, Dr. Weigel first performed an endobronchial ultrasound and found that the lung cancer was just stage I, and not present in any lymph nodes on either side of the trachea. That meant the patient was able to have surgery and final pathology confirmed stage I disease.

"EBUS is really going to help us better know what we're dealing with and hopefully make better choices for the patient," Dr. Weigel says. "The incidence of us having to go to 'Plan B' will be less and less."
 
Date published: 4/28/2008