Open lung biopsy vs. EBUS

PBJ Austin

I had the needle biopsy and although they found no cancer it was rendered inconclusive due to an inadequate sample. I later had the bronchoscopy which came back negative for cancer so they put me on antibiotics, thinking it was an infection. The mass did not shrink after 2 weeks on antibiotics and my test results were negative for infection so they are now talking about another biopsy.
I cannot decide if I should do the EBUS or go straight to the open lung biopsy. As you all know the open lung biopsy is much more invasive, yet it would probably be more accurate than EBUS.
Can anyone shed some light? It's been almost 2 months and I really need answers. Part of me wants the EBUS, but not if it doensn't prove anything and I will need the open lung proceudre later.

Thank you all.

soccerfreaks

EBUS
PBJ, I am not familiar with EBUS, except to know that it is basically an ultrasound on the end of a bronchoscopy, or so I understand it. I know that the hospital where I had my lobectomy done in January of 2008 uses EBUS (now, anyway) but it was either not available or not considered the right thing for me back in the beginning of 2008.

I am sure, though, that you have done your research and are aware that the appropriate medical community considers it to be a rather accurate method for determining what is going on in the lungs without being, as you have pointed out, as invasive as other methods.

I am not sure what you mean by 'open lung surgery' however. When a needle biopsy proved a no-go for me, due to the size and location of the suspect node, my cardiopulmonologist performed a MINIMALLY invasive surgicial procedure to remove the node, and then, when it came back as malignant, to remove the lobe. This procedure, referred to as a VATS surgery, is also hailed for its 'minimally invasive' effects, albeit more invasive than EBUS.

Depending on location, it may be that VATS is not an option for you. On the other hand, your doctors may be completely sold on EBUS.

If it were me, and if I were comfortable with my doctors, I would go with the EBUS if that is what they are recommending. I would, though, ask about VATS and what it entails, just to have that knowledge.

No need to get cut, PBJ, if you really don't have to.

Just one man's opinion.

Take care,

Joe

PBJ Austin

Thanks Joe
I am meeting with the surgeon on Thursday to get more info. If the EBUS is reliable I'll take that in a jiffy!! But with my last 2 biopsies the doctor doesn't seem to completely trust the results and I can't tell if he has confidence in EBUS or not, that's why I'm tempted to move forward with surgery. I just want answers, but of course I want correct answers with as little invasive procedure as possible.

soccerfreaks

PBJ Austin said:

Thanks Joe
I am meeting with the surgeon on Thursday to get more info. If the EBUS is reliable I'll take that in a jiffy!! But with my last 2 biopsies the doctor doesn't seem to completely trust the results and I can't tell if he has confidence in EBUS or not, that's why I'm tempted to move forward with surgery. I just want answers, but of course I want correct answers with as little invasive procedure as possible.

Well
Peanut Butt and Jel...one thing about cancer is that it doesn't adhere to our schedules, no matter what our personality types are (and I am suspecting that you are at least a borderline Type A).

The waiting drives us nuts, I know first-hand, but sometimes that is not just the best course of action but also the necessary course of action.

If you aren't listening to your doctors, however, you certainly aren't going to listen to me.

Whichever way you choose to go, I wish you the best.

Take care,

Joe

PBJ Austin

I am listening
Believe me Joe, I am listening to you and you have been a big help in all of your posts. I'm listening to the doctors too, but sometimes it's hard to make any sense of it all. I will be discussing both options with the surgeon at my appt tomorrow and I will do whatever he suggests. Waiting sucks, but I have learned it's all part of this game.

Thanks for all of your input.

PBJ Austin

PBJ Austin said:

I am listening
Believe me Joe, I am listening to you and you have been a big help in all of your posts. I'm listening to the doctors too, but sometimes it's hard to make any sense of it all. I will be discussing both options with the surgeon at my appt tomorrow and I will do whatever he suggests. Waiting sucks, but I have learned it's all part of this game.

Thanks for all of your input.

VATS
Joe,

VATS has not been mentioned yet and I hadn't heard of it before reading your post. I have done some reading this morning and I will definitely ask about that when I see the doctor tomorrow.

Thanks for everything.

soccerfreaks

PBJ Austin said:

VATS
Joe,

VATS has not been mentioned yet and I hadn't heard of it before reading your post. I have done some reading this morning and I will definitely ask about that when I see the doctor tomorrow.

Thanks for everything.

You are in my thoughts
Hoping that all went well for you PBJ, and that you have reached a decision you are comfortable with.

Please let us know.

Take care,

Joe

PBJ Austin

update
I'm just home from the hospital and very groggy but I wanted to give you an update.

I had the EBUS today and the results are very good as they found no cancer. I'm still having a PET scan next week but both the surgeon and the dr who did the EBUS feel very sure it isn't cancer.

Now here's the not-so-great news. They believe it's a benign, slow growing mass that will not go away on it's own, hence it needs to come out. This will mean the removal of my upper lobe. I know that surgery isn't fun but both doctors agree it must be done.

I'm glad I had the EBUS. Although it did not save me from surgery, at least I know I have exhausted all of my options and I didn't rush into surgery. The doctor will try the less invasive VATS procedure Joe mentioned.

I cannot tell you how much peace of mind I have now that we have answers and a plan.

Thanks to all on this board, you have been such a comfort. Although I don't have lung cancer I will be checking this board often in case I can answer any questions about the biopsies I've had or the lobectomy. And of course I will be a part of the brain cancer forum as my beautiful young sister is battling that monster.

You are all in my heart, thoughts and prayers.

PBJ Austin

Good news indeed
I see this as very good news too. Of course I'm not happy about the surgery but I am so thankful it's not cancer I am still doing a happy dance. Besides, I've known all along that surgery is a possibility so I'm taking that news well.

The surgery is not urgent and doesn't need to be done immediately. But it is a slow-growing mass so over time it will get bigger and cause me more problems if I don't have it removed. I am 45 years old now and surgery doesn't get easier as we age. Right now it measures 7cm x 6cm. I'm probably not getting much function from that lobe anyway since this mass is so large. It will be a relief to get this out and carry on with life.

I will see the surgeon again after my PET scan next week and we will decide when to schedule the surgery. I think it will happen sometime in early September.

Blessings to you all.

soccerfreaks

PBJ Austin said:

update
I'm just home from the hospital and very groggy but I wanted to give you an update.

I had the EBUS today and the results are very good as they found no cancer. I'm still having a PET scan next week but both the surgeon and the dr who did the EBUS feel very sure it isn't cancer.

Now here's the not-so-great news. They believe it's a benign, slow growing mass that will not go away on it's own, hence it needs to come out. This will mean the removal of my upper lobe. I know that surgery isn't fun but both doctors agree it must be done.

I'm glad I had the EBUS. Although it did not save me from surgery, at least I know I have exhausted all of my options and I didn't rush into surgery. The doctor will try the less invasive VATS procedure Joe mentioned.

I cannot tell you how much peace of mind I have now that we have answers and a plan.

Thanks to all on this board, you have been such a comfort. Although I don't have lung cancer I will be checking this board often in case I can answer any questions about the biopsies I've had or the lobectomy. And of course I will be a part of the brain cancer forum as my beautiful young sister is battling that monster.

You are all in my heart, thoughts and prayers.

Good news, bad news
PBJ, this is really great news, all things considered, and I am hopeful that I join you in what should be, relatively, a happy dance.

Coincidentally, someone else on this board or in emotinal support or somewhere was asking why surgery would be necessary if results were negative, and I suggested this very possibility (you can look it up ).

The VATS, PBJ, is not UNinvasive, as my wife likes to point out to me when I laud its benefits on this site and tell her about it, but you have clearly done your research and know what to expect.

I was supposed to get out within four days after they did the lobectomy, via VATS, that removed the lowest lobe of my right lung. I was, in fact, ahead of schedule until something else cropped up.

It IS uncomfortable, but with proper pain management and good nurses and doctors, you should be out there and back home before you know it.

I was advised that I might not be able to run a marathon any more, but I considered that a bonus, as I had not ever run one and now had an excuse should the opportunity present itself, to say no.

I DID ask if I would be able to play the saxaphone, but they had heard that joke before, and so were bright enough to say "Only if you played before", and, alas, I had not. (Well, I had given it a go once, but with extremely marginal results.)

So I still cannot play the saxaphone.

In any event, again congratulations on what is really rather wonderful news.

I wish you the best, and am sure I join others here in doing so.

Take care,

Joe

OncoSurge

PBJ Austin said:

Good news indeed
I see this as very good news too. Of course I'm not happy about the surgery but I am so thankful it's not cancer I am still doing a happy dance. Besides, I've known all along that surgery is a possibility so I'm taking that news well.

The surgery is not urgent and doesn't need to be done immediately. But it is a slow-growing mass so over time it will get bigger and cause me more problems if I don't have it removed. I am 45 years old now and surgery doesn't get easier as we age. Right now it measures 7cm x 6cm. I'm probably not getting much function from that lobe anyway since this mass is so large. It will be a relief to get this out and carry on with life.

I will see the surgeon again after my PET scan next week and we will decide when to schedule the surgery. I think it will happen sometime in early September.

Blessings to you all.

wanted to comment
I just wanted to comment.
EBUS is a very small sample and not definitive. It is an ultrasound guided needle biopsy. If it finds cancer you can be a fairly comfortable it is cancer. If it does not find cancer, it does not mean you are cancer free.

"The EBUS procedure allows physicians to perform a technique known as transbronchial needle aspiration (TBNA) to obtain tissue or fluid samples from the lungs and surrounding lymph nodes without conventional surgery. The samples can be used for diagnosing and staging lung cancer, detecting infections, and identifying inflammatory diseases that affect the lungs, such as sarcoidosis." http://health.ucsd.edu/specialties/pulmonary/procedures/endobronchial.htm

PET scan is used to identify metabolically active areas/masses .... generally cancer. PET scan can be falsely positive if there is an inflamatory process. The PET scan result will not provide a definitive diagnosis. I am not sure why a PET is being ordered if your physician believes this to be a benign process. At this point, you need a good tissue sample for definitive diagnosis. If they are going forward with PET, it sounds like staging.

The question is: how big is the lesion/mass in your lung (7x6cm & growing?) and where is it located? EBUS would usually be sampling either lymph nodes around the airways or a very central lesion. If the lesion is less central and "benign", resection could possibly be achieved with wedge resection as opposed to full lobectomy. If it is more central, then you likely require a lobectomy. In any case, I would not wait any longer. Definitive diagnosis and therapy within a few weeks of identification of a suspicious lesion is in order.

Please be sure you have a skilled thoracic surgeon.

PBJ Austin

OncoSurge said:

wanted to comment
I just wanted to comment.
EBUS is a very small sample and not definitive. It is an ultrasound guided needle biopsy. If it finds cancer you can be a fairly comfortable it is cancer. If it does not find cancer, it does not mean you are cancer free.

"The EBUS procedure allows physicians to perform a technique known as transbronchial needle aspiration (TBNA) to obtain tissue or fluid samples from the lungs and surrounding lymph nodes without conventional surgery. The samples can be used for diagnosing and staging lung cancer, detecting infections, and identifying inflammatory diseases that affect the lungs, such as sarcoidosis." http://health.ucsd.edu/specialties/pulmonary/procedures/endobronchial.htm

PET scan is used to identify metabolically active areas/masses .... generally cancer. PET scan can be falsely positive if there is an inflamatory process. The PET scan result will not provide a definitive diagnosis. I am not sure why a PET is being ordered if your physician believes this to be a benign process. At this point, you need a good tissue sample for definitive diagnosis. If they are going forward with PET, it sounds like staging.

The question is: how big is the lesion/mass in your lung (7x6cm & growing?) and where is it located? EBUS would usually be sampling either lymph nodes around the airways or a very central lesion. If the lesion is less central and "benign", resection could possibly be achieved with wedge resection as opposed to full lobectomy. If it is more central, then you likely require a lobectomy. In any case, I would not wait any longer. Definitive diagnosis and therapy within a few weeks of identification of a suspicious lesion is in order.

Please be sure you have a skilled thoracic surgeon.

Hi Onco
Please see my reply on the "gasping" thread. :-)