LAUSR

Introduction In suspected lung cancer patients, supraclavicular lymph node (SCN) sampling is one of the least invasive methods for obtaining tissue for histology. In our hospital we operate a physician-led ultrasound guided biopsy (USG) service, performing a wide range of diagnostic procedures, including USG SCN sampling. In this retrospective analysis we evaluated the impact of a physician-led biopsy service on the proportion of lung cancer patients who obtained a histological diagnosis through SCN sampling. Methods At our hospital, suspected lung cancer patients who had radiologically reported SCNs on CT chest or those suspected to have SCNs by lung cancer physicians (after reviewing CT imaging) were chosen for an ultrasound scan (USS) of the neck. This was followed by SCN sampling (either fine needle aspiration or/and biopsy) if nodes were present. All patients with a histological diagnosis of lung cancer in 2018 were reviewed to assess the diagnostic method used. We did this by reviewing our local database, results reporting system and procedures logbook. Results 133 patients with a histological diagnosis of lung cancer in 2018 were included in the study. Table 1 summarises the results. SCN sampling confirmed malignancy in 21 cases (16% of all cases). Radiologists reported the presence of SCNs in 17 cases, of which malignancy was confirmed by SCN sampling in 11 cases. Of the remaining 116 cases, physicians suspected SCNs in 32 patients. 25 patients underwent USS neck with 16 undergoing SCN sampling; malignancy was confirmed in additional 10 cases. Of the 7 that did not have USS neck, diagnosis was achieved in 5 through other USG procedures. In the cohort where SCNs were not reported by radiologists, SCN sampling also upstaged the lung cancer in 2 patients and avoided unnecessary staging investigations (e.g. PET-CT) in 3 patients. Conclusion This study suggests that a dedicated physician-led biopsy service can increase the number of patients who obtained a histological diagnosis with SCN sampling. Active review of CT imaging by physicians could significantly improve the identification of small SCNs on CT scans, as radiologists may not report nodes under 1cm in size.Abstract P80 Table 1 Summary of results Number of cases Number undergoing USS neck Number undergoing SCN sampling Number of lung cancers confirmed by SCN sampling (Diagnostic yield) Histologically confirmed lung cancer cases 133 41 29 21 (72%) Patients with CT reporting presence of SCNs 17 16 13 11 (85%) Patients with CT not mentioning presence of SCNs 116 25 16 10 (63%)