Ultrasound Procedures Coupled to Improve Lung Cancer Care

CINCINNATI—UC researchers are studying a new way to more accurately determine the extent of lymph node involvement in patients with lung cancer.

James Knepler, MD, is using endobronchial ultrasound (EBUS) via the airway walls to examine the mediastinum (media-STY-num)—the cavity containing the lungs and heart that lung cancer often spreads to—in order to obtain biopsy tissue.

His collaborator Nathan Schmulewitz, MD, is heading a clinical trial that will couple EBUS with endoscopic ultrasound (EUS)—which examines the mediastinum through the esophagus. The EBUS and EUS procedures will be done on the same day to improve the chances of locating the cancer. Both are performed on an outpatient basis.

According to the American Lung Association, lung cancer is the leading cancer killer in both men and women in the United States. In 1987, it surpassed breast cancer to become the leading cause of cancer deaths in women. 

Knepler, assistant professor of pulmonary medicine, and other UC colleagues are the only physicians performing EBUS in the region.

Before the introduction of EBUS, Knepler said doctors had to perform "blind biopsies" through the wall of the trachea using a small needle.

"Now, we can actually see where the mass is and stick it the first time," he said. "EBUS increases our yield and our accuracy."

Schmulewitz, assistant professor of digestive diseases, said coupling EBUS and EUS will help locate cancer in patients.

"This study is important," he said. "By the time most lung cancer is found, it's often advanced to other areas of the body, and small tumors don't usually cause symptoms."

Schmulewitz said in many cases, cancer has spread to lymph nodes in the mediastinum by the time medical symptoms are recognized. Although some of these patients remain good candidates for surgical removal of tumors, most would not benefit from surgery unless the cancer can be shrunk with chemotherapy.

"Once lung cancer spreads, the chances of curing the patient with surgery are slim," Schmulewitz explained.

Knepler said coupling the procedures will save people from having to undergo a surgical procedure called a mediastinoscopy to see inside the mediastinum.

"Oftentimes we can make a diagnosis without a more invasive procedure," he said. "We don't want someone to have to go to surgery if it isn't beneficial or necessary."

Schmulewitz said this will be the first study in the United States to combine the EBUS and EUS procedures. Nowadays, some patients are being offered either EUS or EBUS but not both on the same day.

"We can possibly save patients a trip to the operating room if we find we can't cure them surgically," he said. "We hope these combined technique will give us more accurate results."