The underutilization of EUS-guided FNA in the lymph-node staging of non-small-cell lung cancer: perceptions of chest physicians in Wisconsin

• Published in: Gastrointestinal endoscopy Vol. 62; no. 4; pp. 517 - 520
• Main Authors: Hernandez, Lyndon V., MD, Geenen, Joseph E., MD, Schmalz, Michael J., MD, Catalano, Marc F., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-10-2005; Elsevier
• Subjects: Biological and medical sciences; Biopsy, Fine-Needle - methods; Biopsy, Fine-Needle - utilization; Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - secondary; Digestive system. Abdomen; Endoscopy; Endosonography - utilization; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Lymphatic Metastasis; Medical sciences; Neoplasm Staging - methods; Pneumology; Practice Patterns, Physicians; Retrospective Studies; Surveys and Questionnaires; Tumors of the respiratory system and mediastinum; Wisconsin; United States; North America; Wisconsin; America; Sonography; Lung disease; Lymph node; Endoscopic route; Respiratory disease; Endoscopic ultrasonography; Physician; Thorax; Malignant tumor; non-small cell lung carcinoma; Aspiration punction; Fine needle; Echography; Bronchus disease; Perception
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2005.04.054

Background Recently, the American College of Chest Physicians (ACCP) published evidence-based guidelines for the invasive staging of non-small-cell lung cancer (NSCLC), which shows the potential value of transesophageal sampling by EUS-guided FNA (EUS-FNA). The objective of the study was to determine the perceptions and the clinical practice of chest physicians regarding EUS-FNA as a staging modality for NSCLC. Methods We mailed a questionnaire to all members of the ACCP in Wisconsin. Results Seventy-one of 173 members (41%) responded. Chest physicians were more likely to perceive positron emission tomography, transbronchial needle aspiration, transthoracic needle aspiration, and mediastinoscopy to be able to make a difference in managing patients with NSCLC instead of EUS-FNA ( p = 0.01). Of the 40 chest physicians who believed that EUS-FNA can change the management of NSCLC, only 8 (20%) have sent a patient for EUS-FNA in the past year. Our findings may not necessarily reflect the opinions of chest physicians in other areas of the United States. Conclusions Many of the chest physicians surveyed do not believe EUS-FNA impacts the management of NSCLC. This limited awareness may represent a barrier to successful utilization of EUS-FNA in lung-cancer staging.