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Title: Improving the clinical performance of endobronchial ultrasound in patients with suspected lung cancer
Author: Evison, Matthew
ISNI:       0000 0005 0288 8215
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2017
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Background: The introduction of endobronchial ultrasound (EBUS) into routine clinical practice has caused a paradigm shift in lung cancer diagnosis and staging. However, despite a rapid expansion of EBUS services, there remain unanswered questions that if addressed have the potential to improve clinical performance and patient care. Aim: To improve the clinical performance of EBUS in patients with suspected lung cancer. Objectives: • To explore the safety and performance of EBUS in elderly patients. • To determine the optimal management of patients after a negative staging EBUS. • To optimise the performance of staging EBUS across a cancer network. • To improve radial EBUS performance when used to sample peripheral lung lesions. Materials and methods: Data was prospectively collected for all EBUS procedures. Safety and performance outcomes were analysed by age group (< 70yrs vs. = 70yrs). Analysis of radiological lymph node characteristics was performed to identify independent predictors of nodal malignancy. Staging EBUS performance was analysed across a cancer network before and after the introduction of quality standards. CT variables were examined to identify predictors of successful radial EBUS-guided transbronchial lung biopsy. Results: EBUS complications were low and did not differ according to age category despite older patients having a worse performance status; whereas procedure tolerance and performance were significantly better in the elderly. A risk stratification model using PET-CT and ultrasound lymph node characteristics separated patients into low risk and high risk groups following negative staging EBUS (NPV 99% and 98% in derivation and validation sets). The sensitivity of staging EBUS across Manchester Cancer falls slightly below that of meta-analysis results at 85% and 86% across two time periods, with some evidence of improvements following the introduction of quality standards though not universal. The "bronchus sign" on CT is the best predictor of success of radial EBUSguided biopsy, above all other factors. Discussion: The clinical performance of EBUS in patients with suspected lung cancer can be improved by providing safe access to elderly patients, selecting high risk patients for mediastinoscopy following negative staging EBUS, widespread performance monitoring and using the bronchus sign to select radial EBUS patients.
Supervisor: Crosbie, Philip Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available