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. 2022 May 5;28(1):10.7196/AJTCCM.2022.v28i1.151.
doi: 10.7196/AJTCCM.2022.v28i1.151. eCollection 2022.

Staging and operability of primary lung cancer in Western Cape Province, South Africa

M A Parker  1 , M S Moolla  1 , G E Paris  2 , C F N Koegelenberg  1
Affiliations

Staging and operability of primary lung cancer in Western Cape Province, South Africa

M A Parker et al. Afr J Thorac Crit Care Med. .

Abstract

Background: Lung cancer is the leading cause of cancer-related death globally and in South Africa. Historically, the majority of patients diagnosed with lung cancer are incurable at presentation.

Objectives: To assess the tumour, nodes, metastasis (TNM) staging of lung cancer in a centre with access to both positron emission tomography-computed tomography (PET-CT) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) using a structured diagnostic approach and to compare results with a historical cohort from 2009 from the same hospital.

Methods: A retrospective descriptive observational study was performed using the registry of a high-volume tertiary hospital's weekly multidisciplinary thoracic oncology meeting (MDT). A structured diagnostic approach was used for staging purposes. All patients with a tissue diagnosis of primary lung cancer and adequate imaging (chest CT and/or PET-CT) who presented at the MDT during the period from 1 January - 31 December 2019 were included. Final staging and tissue diagnoses were documented and compared with a historical cohort from 2009 from the same institution.

Results: Adenocarcinoma was the most common subtype (38.8%; n=116). Less than a tenth of patients (6.3%; n=16/254) with non-small cell lung cancer had potentially curable lung cancer (stage IA to IIIA) at presentation, significantly less than the 2009 cohort (14.5%; n=25/173; p=0.007). The most common procedure administered on patients was transthoracic needle aspiration (37.54%; n=112), followed by conventional bronchoscopic needle aspiration or biopsy (20.4%; n=61), and EBUS-TBNA (17.1%; n=51/299). After PET-CT, 19/30 cases were upstaged including 9/18 from potentially resectable to unresectable. Two of these cases were down-staged to potentially resectable following EBUS-TBNA.

Conclusion: There was a significant decline in resectable and potentially curable lung cancer at presentation over a 10-year period. PET-CT and EBUS-TBNA improved the accuracy of non-small cell lung cancer staging among patients with resectable and potentially curable lung cancer but have exposed a higher stage profile.

Keywords: cancer staging; endobronchial ultrasound; lung cancer; positron emission tomography.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Fig. 1
Fig. 1
Staging algorithm for lung cancer at Tygerberg Hospital. CT = computed tomography PET = positron emission tomography M = metastasis LN = lymph node EBUS = endobronchial ultrasound TTNA = transthoracic needle aspirate
Fig. 2
Fig. 2
Consort diagram of patients included in the study and analyses.
See this image and copyright information in PMC

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