NEW YORK (Reuters Health) - Endobronchial ultrasound (EBUS) doesn't improve cancer detection in peripheral lung lesions, Norwegian researchers have found.
Instead, biopsy plus brushing is most cost-effective for this purpose.
"Endobronchial difficulty was the strongest predictor of the diagnostic yield in peripheral lesions. In patients with a bronchial branch going straight to the lesions, physicians with various levels of experience had a high diagnostic yield with or without EBUS," said Dr. Kjetil Roth in email to Reuters Health.
In fact, he said, the diagnostic yield with EBUS was actually lower if the lesions were below 3 cm or difficult to reach.
In an April 11 online paper in Lung Cancer, Dr. Roth of Haukeland University Hospital, Bergen, and colleagues describe a trial in which they randomized 264 patients with suspicious lesions to receive x-ray fluoroscopy with or without EBUS.
The detection rate for cancer was 36% in the EBUS group, not significantly different from the 44% in the non-EBUS group.
However, lesions visualized by EBUS had a significantly higher detection rate for cancer than lesions not visualized by EBUS (62% versus 19%).
As part of a cost effectiveness analysis, the investigators employed brushing, biopsy, transbronchial needle aspiration, and washing in 178 patients regardless of randomization. Brushing plus biopsy increased the detection rate to 43.8%, compared to 36.7% for biopsy alone. With this approach, it cost 1211 euros to detect each additional positive sample.
Instead of EBUS, which did not increase the diagnostic yield in peripheral lesions, biopsy and brushing was the most cost-effective combination of sampling techniques, the research team concludes.
By David Douglas
Source: http://bit.ly/kksPgO
Lung Cancer 2011.
Last Updated: 2011-05-10 19:00:29 -0400 (Reuters Health)
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