The importance of ultrasound in staging and gaining a pathological diagnosis in patients with lung cancer--a two year single centre experience

Abstract

Background Initial studies on the use of ultrasound in the detection and sampling of supraclavicular lymph nodes in patients with suspected lung cancer show this to be a promising technique, giving both a cytological diagnosis and pathological N3 (pN3) stage. Leicester published its initial experience in 2005 and the aim of this study was to establish if this had been embedded into the diagnostic pathway, and further to examine the use of ultrasound in diagnosing and staging lung cancer by imaging other areas including pleural effusions, chest wall, bone and liver lesions. Methods All patients diagnosed with lung cancer, registered on the Leicester lung cancer database over a two year period between January 2007 and December 2008, had their imaging and pathology retrospectively reviewed; 996 primary lung cancer patients were identified (n¼996). Of these, 318 patients underwent an ultrasound examination (n¼318), consisting of ultrasound of the neck, pleural cavity, and metastatic lesions potentially amenable to ultrasound guided aspiration/biopsy. Results The overall malignant yield was 45% of patients scanned (95% CI 39.5% to 50.4%) and 81.3% of patients sampled (95% CI 75.5% to 87%). Of the 996 patients, 14.4% (n¼143) had a positive ultrasound guided cytological diagnosis (95% CI 12.2% to 16.5%). Of all the pathological diagnoses (n¼765), 18.7% were ultrasound guided (95% CI 15.9% to 21.5%). In particular, 32.2% of patients with CT detected neck or mediastinal nodes had a diagnosis and stage achieved by neck ultrasound. Conclusion The use of ultrasound gives a rapid and less invasive method of diagnosing and staging lung cancer and has become embedded into the diagnostic pathway. We advocate its increased use and availability in patients with lung cancer.

A practical guide to transthoracic ultrasound

“…FNA of extrathoracic lymph nodes can even be performed outside of a dedicated operating theatre at the patient's bedside [10].…”

“…Air bronchograms appear as dynamic echogenic branches and foci that fluctuate with the respiratory cycle [1][2][3]5]. Fluid bronchograms are seen as anechoic tubular structures and represent fluid-filled airways [2,10]. Furthermore, ultrasonography is ideally suited to screen for parapneumonic effusions and to differentiate dense consolidation from pleural effusions in critically ill patients ( fig.…”

Transthoracic Ultrasonography for Clinicians

“…Drowned lung is considered to represent accumulated secretions and is typified on US by fluid bronchograms, provided it extends to the pleura (8). USassisted TTFNA of a drowned lung can be diagnostic in almost 75% of cases, and it may represent a viable alternative to bronchoscopy in selected cases (53,54).…”

Percutaneous Ultrasonography as Imaging Modality and Sampling Guide for Pulmonologists

“…One study from a single centre lung cancer registry showed that 14.4% of patients were diagnosed with US-guided samples from either pleura, supraclavicular nodes or distant metastatic disease [57]. Another prospective study in patients suspected for thoracic malignancy showed that 13% of diagnoses were obtained with percutaneous US-guided biopsies or aspirations without the need for other invasive tests.…”