Role of physician-led neck ultrasound screening in lung cancer diagnostics

Abstract

<bold>Background:</bold> Cervical lymph node (LN) involvement is common in lung cancer. US successfully detects these LNs and allows timely sampling. This study aimed at evaluating the value of physician-led neck US (NUS) screening in patients with new lung cancer diagnosis. <bold>Methods:</bold> this was a prospective study in lung cancer clinics in 3 hospitals (2 in UK, 1 in Egypt) over 16-week period. Patients with radiological lung cancer who had evidence of N1-3 or M disease underwent a screening NUS in clinic. Patients with abnormal LNs on NUS had their LNs sampled as the primary test for tissue diagnosis. The prevalence of nodal disease, diagnostic yield of LN sampling and ranges of procedures avoided were recorded. <bold>Results:</bold> 153 patients (92 (60%) males, mean age 64+12.4 years) underwent NUS. Abnormal neck LNs were seen in 66 (43%), 21% of patients with N1 disease, 31% in N2 disease and 68% in N3 disease. 38 patients underwent neck LN sampling. Time from NUS screen to biopsy was 1 [0-2] working days. 3(7.8%) samples were non-diagnostic and 2 samples showed reactive nodal tissue. 33 nodal samples were positive for lung cancer. Samples were sufficient in 10/11 (91%) cases when molecular testing was needed. No significant complications were recorded. Of the 33 biopsy-proven neck LN metastases, 17 (52%) were missed on CT reports. 28 EBUS/bronchoscopy, 3 thoracoscopies and 2 CT-guided lung biopsies were avoided because of neck LN sampling. <bold>Conclusion:</bold> NUS screening in Lung Cancer diagnosis is feasible in different healthcare settings. It facilitates low-cost, timely and less invasive tissue diagnosis in more than 1 in 5 patients with thoracic adenopathy. Relying on the CT report to rule out abnormal neck LNs may not be sufficient.