Holden Van K, Wappel Stephanie, Verceles Avelino C, Deepak Janaki
VA Maryland Health Care System, Baltimore VA Medical Center, 10 N. Greene St., Baltimore, MD, USA 21201.
Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 110 S. Paca St., 2 Floor, Baltimore, MD, USA 21201.
Ann Lung Cancer. 2019;3(1):66-74. Epub 2019 Jun 14.
Endobronchial ultrasound (EBUS) is commonly employed in the diagnostic evaluation of pulmonary nodules and for mediastinal staging of lung cancer. We hypothesized that the establishment of an onsite EBUS program would decrease the time to the diagnosis and treatment of detected malignancy in veterans seen in a dedicated pulmonary nodule clinic.
We conducted a retrospective chart review of patients seen at the Baltimore Veterans Affairs Medical Center (BVAMC) pulmonary nodule clinic and required diagnostic evaluation. One hundred and fifty consecutive patients before and after implementation of an onsite EBUS program were screened.
Forty-nine patients from the pre-intervention group and 41 patients from the post-intervention group underwent diagnostic evaluation and were included in study analyses. There was no significant difference in the median number of days between CT chest and initial visit to the BVAMC Lung Mass Clinic (22 vs. 14 days, P = 0.06), CT chest to diagnostic procedure (47.5 vs. 37 days, P = 0.33), and CT chest to initial treatment of detected malignancy (103 vs. 88 days, P = 0.15). There was no significant difference in the lung cancer stages or 1-year mortality between groups. A total of 76 barriers to care were identified among the 90 patients.
There was a trend towards improving the time from the initial CT chest to the treatment of cancer with onsite availability of EBUS. More efforts need to be done to decrease the modifiable barriers to treatment to improve the overall lung cancer care for veterans.
支气管内超声（EBUS）常用于肺结节的诊断评估以及肺癌的纵隔分期。我们推测，在专门的肺结节诊所为退伍军人建立现场EBUS项目将减少确诊恶性肿瘤并开始治疗的时间。
我们对巴尔的摩退伍军人事务医疗中心（BVAMC）肺结节诊所就诊且需要进行诊断评估的患者进行了回顾性病历审查。对实施现场EBUS项目前后的150例连续患者进行了筛查。
干预前组的49例患者和干预后组的41例患者接受了诊断评估并纳入研究分析。胸部CT检查至首次就诊于BVAMC肺部肿块诊所的天数中位数无显著差异（22天对14天，P = 0.06），胸部CT检查至诊断程序的天数中位数无显著差异（47.5天对37天，P = 0.33），胸部CT检查至确诊恶性肿瘤开始初始治疗的天数中位数无显著差异（103天对88天，P = 0.15）。两组之间的肺癌分期或1年死亡率无显著差异。在90例患者中总共识别出76个护理障碍。
现场配备EBUS有缩短从首次胸部CT检查到癌症治疗时间的趋势。需要做出更多努力以减少可改变的治疗障碍，从而改善退伍军人的整体肺癌护理。
