Division of Pulmonary and Critical Care Medicine, University of California, Los Angeles, 10833 LeConte Avenue, Los Angeles, CA, 90095, USA.
Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Lung. 2019 Apr;197(2):249-255. doi: 10.1007/s00408-019-00207-6. Epub 2019 Feb 19.
While there is significant mortality and morbidity with lung cancer, early stage diagnoses carry a better prognosis. As lung cancer screening programs increase with more pulmonary nodules detected, expediting definitive treatment initiation for newly diagnosed patients is imperative. The objective of our analysis was to determine if the use of a dedicated interventional pulmonology practice decreases time delay from new diagnosis of lung cancer or metastatic disease to the chest to treatment initiation.
Retrospective chart analysis was done of 87 consecutive patients with a new diagnosis of primary lung cancer or metastatic cancer to the chest from our interventional pulmonology procedures. Demographic information and time intervals from abnormal imaging to procedure and to treatment initiation were recorded.
Patients were older (mean age 69) and former or current smokers (72%). A median of 27 days (1-127 days) passed from our diagnostic biopsy to treatment initiation. A median of 53 total days (2-449 days) passed from abnormal imaging to definitive treatment. Endobronchial ultrasound-guided transbronchial needle aspiration was the most commonly used diagnostic procedure (59%), with non-small cell lung cancer the majority diagnosis (64%). For surgical patients, all biopsy-negative lymph nodes from our procedures were cancer-free at surgical excision.
Compared to prior reports from international and United States cohorts, obtaining a tissue biopsy diagnosis through a gatekeeper interventional pulmonology practice decreases median delay from abnormal imaging to treatment initiation. This finding has the potential to positively impact patient outcomes and requires further evaluation.
尽管肺癌的死亡率和发病率很高,但早期诊断的预后较好。随着肺癌筛查计划的增加,检测到的肺结节越来越多,为新诊断的患者尽快启动明确的治疗至关重要。我们分析的目的是确定使用专门的介入肺病学实践是否会缩短从新诊断的肺癌或转移性疾病到胸部治疗开始的时间延迟。
对我们介入肺病学程序中新诊断的原发性肺癌或转移性肺癌的 87 例连续患者进行回顾性图表分析。记录人口统计学信息和从异常影像学到程序以及开始治疗的时间间隔。
患者年龄较大(平均年龄 69 岁)且为前吸烟者或现吸烟者(72%)。从我们的诊断性活检到开始治疗的中位数为 27 天(1-127 天)。从异常影像学到明确治疗的中位数为 53 天(2-449 天)。经支气管超声引导下经支气管针吸活检是最常用的诊断程序(59%),非小细胞肺癌是大多数诊断(64%)。对于手术患者,我们的程序中所有活检阴性的淋巴结在手术切除时均无癌症。
与国际和美国队列的先前报告相比,通过把关介入肺病学实践获得组织活检诊断可缩短从异常影像学到治疗开始的中位时间延迟。这一发现有可能对患者的结果产生积极影响,需要进一步评估。