Implementation of endoscopic ultrasound for lung cancer staging.

BACKGROUND: EUS-guided FNA is currently advocated in lung cancer staging guidelines as an alternative for surgical staging to prove mediastinal metastases. To date, training requirements for chest physicians to obtain competency in EUS for lung cancer staging are unknown. OBJECTIVE: To test a training and implementation strategy for EUS for the diagnosis and staging of lung cancer. DESIGN: Prospective national multicenter implementation trial. Nine (chest) physicians from 5 hospitals participated in a dedicated EUS educational program (investigation of 50 patients) for the diagnosis and staging of lung cancer. EUS outcomes of trainees were compared with those of the training center. SETTING: Four general hospitals, the national cancer center (implementation centers), and a tertiary referral center (expert center). PATIENTS: This study involved 551 consecutive patients with (suspected) lung cancer, all candidates for surgical staging, who underwent EUS in 1 of the 5 implementation centers (n = 346) or the single expert center (n = 205). Surgical-pathological staging was the reference standard in case no mediastinal metastases were found. RESULTS: EUS had a sensitivity of 83% versus 82% and accuracy of 89% versus 88% for mediastinal nodal staging (implementation center vs expert center). Surgery was spared because of EUS findings in 51% versus 54% of patients. A single complication occurred in each group. LIMITATION: Surgical-pathological verification of mediastinal nodes was not available in all patients staged negative at EUS. CONCLUSION: Chest physicians who participate in a dedicated training and implementation program for EUS in lung cancer staging can obtain results similar to those of experts for mediastinal nodal staging.

High F-18 FDG uptake in bone marrow by cytokines secreting ectopic mucoepidermoid carcinoma.

A 57-year-old woman, just returned from a bicycling holiday in the mountains, presented with discomfort, hoarseness and chronic cough complaints. After chest x-ray, bronchoscopy and fluoro-deoxy-glucose positron emission tomography/computed tomography (F-18 FDG PET/CT), a diagnosis of a tumor in the bronchus of the right upper lobe with obstruction pneumonia was made. After lobectomy of the right upper lobe, pathology revealed an ectopic bronchial low-grade mucoepidermoid carcinoma.The diffuse high FDG uptake in the bone marrow standardized uptake value (SUV mean 3.6 and max 5.2) is unlikely to be related to bone marrow stimulation due to pneumonia, but correlates with a high serum level of correlated with transforming growth factor-beta (TGF-beta1) secreted by the low-grade bronchial mucoepidermoid carcinoma.