Lung cancer tracking studied

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http://news.enquirer.com/apps/pbcs.dll/ ... 1056/COL02

Project using dual ultrasounds being done at UC

BY PEGGY O'FARRELL | POFARRELL@ENQUIRER.COM

University of Cincinnati researchers want to know if combining two procedures can give doctors a better read on whether lung cancer has spread to patients' lymph nodes.

If the combination is a better option, it could help doctors catch lung cancer earlier and spare patients surgeries to check on the spread of the disease, say pulmonologist James Knepler and digestive disease specialist Nathan Schmulewitz. They are heading up the study.

Lung cancer is the leading cause of cancer death in the United States.

In 2007, about 213,380 new cases of lung cancer will be reported, according to the American Cancer Society, and about 160,390 people will die of the disease.

For the study, doctors will use two types of ultrasound imaging in combination with a needle biopsy to collect suspected cancerous tissue from lymph nodes in the muscular cavity that houses the lungs and heart. Lung cancer often spreads into the cavity.

One type of imaging, called endobronchial ultrasound, or EBUS, lets doctors view the cavity through the airways.

"Before, we couldn't see back in there," Knepler said. "We'd take the needle and go in blind to collect the sample. With EBUS, we can actually see the needle going into the lymph node, so we know for a fact that we got the tissue."

The second type of imaging shows the cavity - called the mediastinum - through the esophagus.

Using the two imaging techniques during the needle biopsy will give doctors a more accurate view of suspect masses and let them get good tissue samples.

Lung cancer has often spread to the lymph nodes and other surrounding tissues by the time it's found, Schmulewitz said. By then, it's often too late to treat it with surgery alone.

And a traditional needle biopsy, performed without ultrasound imaging, can be unsuccessful.

In that case, patients might have to undergo surgery so doctors can get a look inside the cavity housing the lungs.

Anything that spares patients a surgical procedure and gets them the right treatment quickly is a good move, said Rebecca Bechhold, an oncologist with Oncology-Hematology Care Inc. in Blue Ash.

Some lung cancer patients can be treated with surgery only, as long as the cancer hasn't spread to lymph nodes or other parts of the body, Bechhold said.

But doctors need an accurate assessment of the cancer's spread before they can decide whether surgery is the best option, or radiation and chemotherapy are more appropriate.

"It spares the patient that extra surgery, if it's not appropriate. There's less recovery time, and you're not delaying treatment with chemotherapy and radiation," she said.

Bechhold stressed, though, that while imaging technology like ultrasound, CT scans and MRIs are impressive, oncologists still need the actual tissue - not just a picture of it - to know what's cancerous and how to best treat it.

Doctors will soon begin recruiting about 300 subjects from among patients scheduled for lung biopsies for the study, Schmulewitz said.

The UC study will be the first combining the two ultrasound procedures. Some patients are now offered one procedure or the other, but not both on the same day, he said.