Abstract
Introduction: Given the expansion of EBUS services in recent years, there is a need to ensure timely and equitable access to quality assured EBUS for lung cancer patients.
Materials and Methods: In 2012, the number of centres providing EBUS in the former Greater Manchester and Cheshire Cancer Network increased from one to four. This prompted the development of a Network EBUS sub-group and service specification mandating the collection of pre-defined data for all procedures. Analysis of the prospectively maintained central database was undertaken for this report.
Results: From the 1st January 2012 to 30th September 2013, 758 lung cancer patients underwent EBUS-TBNA. Fifty six per cent of procedures (425/758) were for nodal staging with the remainder for pathological diagnosis. The mean time from referral to procedure was 7.4 days (SD +/-4.9). There were 6 major complications (0.7%). 4.8% (43/894) of lymph nodes were inadequately sampled and malignancy was confirmed in 496 lymph nodes. The overall sensitivity and negative predictive value was 84.5% (CI 81.4-87.2%) and 75.6% (CI 71.0-79.7%) respectively, when inadequate results are classified as false-negatives. There was variability in the rate of missing data, inadequate sampling, sensitivity, negative predictive value and rate of surgical sampling of negative nodes across the EBUS centres.
Discussion: A collaborative approach to the provision of EBUS services in a Cancer Network is feasible. All centres need to reduce variation in key outcomes. We believe that quality assurance of EBUS services should be mandated by all Cancer Networks to ensure best outcomes for all patients.
- © 2014 ERS