Favourable Prognosis when Lung-Cancer Patients with Superior Vena Cava Obstruction (SVCO) are Referred Promptly to EBUS-TBNA Prior to Medical or Surgical Management.

BACKGROUND: Primary care patients with superior vena cava obstruction (SVCO) syndrome are usually referred to emergency departments for urgent medical management (high-dose corticosteroids to reduce inflammation), pre-biopsy radiotherapy and/or stent placements to restore patency to the vessel. Biopsy, diagnosis and staging of the mediastinal mass is often postponed until resolution of SVCO symptoms. However, lung cancers metastasise rapidly and delays can influence the eventual outcome of patients. An additional merit in treating SVCO symptoms post-biopsy is that high-dose corticosteroids and pre-biopsy radiotherapy will degrade the quality of biopsy specimens, complicating diagnosis and subsequent management. AIMS: To determine if direct referrals of SVCO patients from primary care to the respiratory department for Endobronchial ultrasound (EBUS)-transbronchial needle-aspiration (TBNA) resulted in better outcomes.
METHODS: Direct referrals to the respiratory department from primary care physicians were sought. A total of 8 patients with symptoms of SVCO were rapidly diagnosed via EBUS-TBNA and ROSE, radiotherapy and specific chemotherapy was initiated following communication with oncology colleagues. High-dose corticosteroids were administered post-EBUS.
RESULTS: Rapid resolution of symptoms for SVCO were noted, without need for surgical intervention. In particular, one patient with small-cell lung cancer (the most aggressive type of lung cancer) remains well and cancer-free 14 months from diagnosis. DISCUSSION: EBUS-TBNA is a safe modality for biopsy in SVCO as there is no risk of further compression of the vessel. We need a paradigm shift in referral and a guideline of SVCO patients in primary care, an urgent biopsy is important in mediastinal cancers which have high metastatic potentials.