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S. Parrish
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P3.06 - Poster Session/ Screening and Early Detection (ID 220)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.06-016 - Upstaging of Lung Cancer - Use of Endobronchial Ultrasound in the Prediction of T4 Disease (ID 2462)
09:30 - 09:30 | Author(s): S. Parrish
- Abstract
Background:
There has been an increased utilization of radial and convex probe endobronchial ultrasound with application in the nodal staging of the mediastinum for bronchogenic carcinoma. Prior work has demonstrated that vascular invasion (Vi) is associated with upstaging and a worsened prognosis in those patients with non-small cell carcinoma. Utilization of endobronchial ultrasound has been promulgated to improve the sensitivity of transbronchial needle aspiration (TBNA), but also to avoid vascular puncture. As such, imaging of the pulmonary vasculature is routinely performed and may allow insight and confirmation of CT imaging of vascular invasion.
Methods:
We present the case of a patient presenting with scant hemoptysis where the CT scan was interpreted as possible invasion of the right pulmonary artery (Fig 1). The literature was reviewed as to the effect of vascular invasion on upstaging patients with lung cancer and he underwent a diagnostic procedure.
Results:
Bronchoscopy and endobronchial ultrasound were performed to allow nodal TBNA to permit pathologic diagnosis and staging of the patient’s identified lung mass. During the procedure, ultrasound of the pulmonary vasculature revealed extensive invasion and mass effect from the central tumor mass (Fig 2). Using these synergistic techniques, the patient was upstaged to T4 and was referred for consultation with medical and radiation oncology. Fig. 1: Figure 1 Fig. 2: Figure 2
Conclusion:
Vascular invasion has previously been demonstrated to result in upstaging and a poorer prognosis. Critical to the workup, then, is not only diagnostic pathology, but also rapid and accurate staging and a decision regarding appropriateness of surgical resection. We believe our case illustrates that with the synergistic use of convex or radial endobronchial ultrasound during initial bronchoscopy, vascular invasion may be accurately confirmed resulting in improved decisions in patient care.
