EBUS Speeds Lung Cancer Diagnosis and Staging
Endobronchial ultrasound is an innovative procedure that diagnoses and stages lung cancer in one nonsurgical outpatient visit. North Kansas City Hospital expects to offer the procedure in early 2015.
“EBUS is a less invasive method for catching lung cancer in its early stages,” says Justin Ranes, MD, a pulmonologist with Meritas Health Pulmonary Medicine.
EBUS allows physicians to obtain tissue or fluid samples from the lungs and surrounding lymph nodes via transbronchial needle aspiration. A pulmonologist guides a special endoscope fitted with an ultrasound processor and a fine-gauge aspiration needle through the patient’s trachea and conducts a real-time biopsy that quickly determines whether more testing is required.
“The critical factors with lung cancer are quick diagnosis and to know how far it has spread,” he says. To speed the diagnosis, EBUS can normally be scheduled in less than a week.
“We want to know the results quickly so we can help the patient plan for the next step. A faster diagnosis translates into faster treatment, and this is one tool to stratify their risk,” says Dr. Ranes.
“Frequently, when patients go to the ER for chest pain or breathing problems, a CT scan incidentally finds a lung nodule. Or the primary care physician sends a long-time smoker for a low-dose CT scan and abnormalities are found,” he says. “The next step should be for the patient to come to us for further evaluation.”
EBUS requires general anesthesia and it takes at least one hour to obtain samples from the mediastinal and hilar lymph nodes. An ultrasound probe looks through the wall of the trachea to find the enlarged lymph nodes visible on a CT scan.
“The first place to biopsy is not the lung, but the enlarged lymph nodes because there you get two answers. You know if it’s cancer and if it’s spread,” Dr. Ranes explains.
“A pathologist immediately reviews the slide sample and can give a preliminary report 90% of the time – a rapid onsite evaluation or ROSE,” he adds. The official report is available in 48 hours. If the biopsy shows the tumor has spread, the patient is referred for surgery, chemotherapy, radiation or other treatments.
To develop his skills, Dr. Ranes spent one week at Mayo Clinic learning about the procedure and completed a course through the American College of Chest Physicians (ACCP). He has performed more than 200 EBUS procedures over the past 3 years.
Both he and his wife Rozella Ranes, MD, serve patients in the Northland. She is a family medicine physician at Meritas Health Gashland in North Kansas City.
To learn more, call 816.691.5098.
Justin Ranes, MD, FCCP
Dr. Ranes received his medical degree from the University of Missouri – Kansas City School of Medicine. He completed his residency in internal medicine and a fellowship in pulmonary/critical care at the Cleveland Clinic Foundation. He is board certified in internal medicine, pulmonary medicine and critical care medicine.