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Observational Study
. 2023 Jun 14;23(1):206.
doi: 10.1186/s12890-023-02508-2.

Safety and utility of Endoscopic Ultrasound with Bronchoscope-guided Fine Needle Aspiration (EUS-B-FNA) in suspected lung cancer patients with poor respiratory or general conditions: a prospective three-center observational study

Koki Nakashima  1   2 , Yukihiro Umeda  3 , Yoshiki Demura  4 , Toshihiro Takeda  4 , Toshihiko Tada  4 , Masayuki Sato  5 , Norihiro Jikuya  4 , Kosuke Kurokawa  4 , Tomoaki Sonoda  3 , Makiko Yamaguchi  3 , Miho Mitsui  3 , Masahiro Oi  4 , Ryo Chikazawa  5 , Yuko Waseda  3 , Masaki Anzai  3 , Masaya Akai  4 , Tamotsu Ishizuka  3
Affiliations
Observational Study

Safety and utility of Endoscopic Ultrasound with Bronchoscope-guided Fine Needle Aspiration (EUS-B-FNA) in suspected lung cancer patients with poor respiratory or general conditions: a prospective three-center observational study

Koki Nakashima et al. BMC Pulm Med. .

Abstract

Background: Although transbronchial diagnostic procedures are sometimes difficult to perform because of the patient's respiratory or general conditions, endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA), a known transesophageal diagnostic procedure, might be useful for such cases. We conducted this prospective three-center observational study to evaluate the safety and efficacy of EUS-B-FNA in suspected lung cancer patients with poor respiratory or general conditions.

Methods: Patients with suspected lung cancer with respiratory failure, Eastern Cooperative Oncology Group performance status of 2 or higher, or severe respiratory symptoms, were enrolled. The primary endpoints were the diagnostic yield of lung cancer and its safety, and the secondary endpoints were the success rate of molecular and programmed death ligand 1 (PD-L1) analyses, and the 6-month survival rate in patients with lung cancer.

Results: We enrolled 30 patients, of which 29 were included in the analysis. Among them, 26 were eventually diagnosed with lung cancer. The diagnostic yield for lung cancer was 100% (26/26). There were no adverse events associated with EUS-B-FNA requiring procedure discontinuation. The success rates of molecular analysis for EGFR, ALK, ROS-1, and BRAF were 100% (14/14), 100% (11/11), 100% (9/9), and 75% (6/8), respectively. The success rate of the PD-L1 analysis was 100% (15/15). The 6-month survival rate in patients with lung cancer was 53.8% (95% confidence interval [CI]: 33.4-76.4), and the median overall survival (OS) was 196 days (95% CI: 142-446).

Conclusions: EUS-B-FNA is a safe and effective diagnostic method, even in patients with suspected lung cancer with poor respiratory or general conditions.

Trial registration: This clinical trial was registered at https://www.umin.ac.jp/ctr/index.htm (UMIN000041235, approved on 28/07/2020).

Keywords: Driver oncogene; Endoscopic ultrasound with bronchoscope-guided fine needle aspiration (EUS-B-FNA); Lung cancer; Next-generation sequencing (NGS); Programmed death ligand 1 (PD-L1).

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram for patient selection
Fig. 2
Fig. 2
Kaplan–Meier estimates for overall survival in all patients with lung cancer. The median overall survival (OS) was 196 days (95% CI: 142-not reached [NR])
See this image and copyright information in PMC

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