Endobronchial Ultrasound in the Evaluation of Lung Cancer: A Practical Review and Cost Analysis for the Practicing Pulmonologist

Abstract

Flexible bronchoscopy remains an important tool in the staging, diagnosis, and treatment of primary and metastatic lung malignancies. Endobronchial ultrasound is a new technology utilized with bronchoscopy that has been shown to identify bronchial wall invasion by malignant tumors, aid in the fine needle aspiration of peripheral lung lesions and mediastinal/hilar lymph nodes, and determine the course of treatment in patients with pulmonary carcinoma in situ. The decision to invest both time and money in this technology is determined by several factors such as the cost of the equipment, reimbursement for the procedure, availability of training, the number of bronchoscopies one performs in a year, and access to endoscopic ultrasound and mediastinoscopy. This article reviews the literature to determine the utility of endobronchial ultrasound in the management of patients with lung cancer and to provide information to practicing pulmonologists that may aid in determining whether and where this technology fits into their clinical armamentarium.

Endobronchial ultrasound‐guided transbronchial needle aspiration cytology: a state of the art review

“…76 Documentation of downstaging (complete pathological response in N2 lymph nodes) is essential for such potentially curative resection. 79 All other diagnostic techniques also show lower restaging sensitivity and accuracy than that achieved in mediastinal staging 47,48 due to the effects of chemotherapy and radiation on tissues with ensuing fibrosis, and of tumour shrinkage, necrosis and cystic degeneration. 14 EUS-FNA, 77 EBUS-TBNA 78 or both can be performed depending on the location of the lymph nodes initially involved.…”

“…The cost of the equipment is about $100 000 for the convex probe EBUS bronchoscope and linear processor; 48 each disposable biopsy needle costs an additional $90. 6 Other costs include the devices used to record or document the EBUS procedure and TBNA and the costs of maintaining and repairing the instruments.…”

“…Compared with initial mediastinoscopy, repeat mediastinoscopy is associated with lower sensitivity and diagnostic accuracy. 79 All other diagnostic techniques also show lower restaging sensitivity and accuracy than that achieved in mediastinal staging 47,48 due to the effects of chemotherapy and radiation on tissues with ensuing fibrosis, and of tumour shrinkage, necrosis and cystic degeneration. It should be stressed that a diagnosis of malignancy in such cases should be made only when intact tumour cells are clearly identifiable, and not on necrotic debris and rare necrotic ÔghostÕ tumour cells.…”

Determinants of Practice Patterns and Quality Gaps in Lung Cancer Staging and Diagnosis

“…[27][28][29][30] Regional or structural differences in insurance companies may also be contributing. It is frequently the case that guidelines call for no biopsy of the primary tumor but rather a PET scan to identify extent system of Medicare, which pays for ultrasound facilities fees for endoscopy but not bronchoscopy.…”

Development and organization of an interventional pulmonology department

“…The IP team should be large enough to be able to provide emergency services even when a procedure is ongoing in the procedure suite. Specific Table 1 Types of procedures and potential location for an interventional pulmonology department [7][8][9][10][11][12][13] Types of procedures that may be included …”