Lothian leading the way in cancer care

PHYSICIANS in Edinburgh are pioneering a new form of diagnostic procedure that could help them in the treatment of patients with lung cancer.

The Royal Infirmary of Edinburgh is one of only two reference centres in the UK for this procedure – called the Endobronchial Ultrasound (EBUS) – and its doctors are among the world’s leading experts in this subject.

The new technique combines a bronchoscope – a narrow tube with a camera and sampling instruments attached, which is passed into the patient’s airways – and an ultrasound probe.

The latter allows doctors to study images beneath the surface of the bronchial wall and check if the cancer has spread to the lymph nodes.

Callum Gordon, service manager for cardiac, thoracic and respiratory services at NHS Lothian, said:


“EBUS is a much more effective tool than astraightforward bronchoscopy. It allows specialists to remove much finer tissue samples from the areas they’re looking at, and allows them to identify how far the disease has progressed.
“If the tumour has not yet spread to the lymph nodes surrounding the lungs, the patient may be suitable for surgery, which improves his/her chances of staying cancer free.
“If the cancer has spread, then an operation may not be the best route, and other forms of treatment such as radiotherapy or chemotherapy may be more suitable.
“EBUS gives doctors better information as to the state of the disease and helps them make treatment decisions at an earlier stage on the patient pathway. It’s early days, but the future for EBUS looks promising.”
In the past two years, EBUS has reduced the number of mediastinoscopies – where surgeons operate to investigate the spread of the cancer – by 20 per cent, and experts are convinced the number may be further reduced in the near future.
Dr Kris Skwarski, respiratory physician from the Royal Infirmary ofEdinburgh, has been leading the interventional bronchology research team for NHS Lothian for the last four years, and has performed about 500 EBUS procedures already.


He said:
 EBUS was developed in Japan. The manufacturers, KeyMed Olympus UK, decided that NHS Lothian doctors were sufficiently competent in the use of another ultrasound technique called EUS (Endoscopic Ultrasound) and gave us the task of developing a reference centre for EBUS in the UK.”
Dr Skwarski has trained Dr John McCafferty, Consultant Respiratory Physician from St John’s Hospital in Livingston. He has also providedbackground teaching in using the EBUS technique for colleagues from around Scotland, England and from overseas.
Dr Ron Fergusson is NHS Lothian’s lead lung cancer clinician. He said:
“There are only a handful of centres worldwide with more experience of a technique which I believe will become a standard part of lung cancer management in the future.
“Accurate staging of the extent of lung cancer is vital to plan appropriate treatment and to give the patient and their family a better guide to prognosis. EBUS helps us to plan the correct treatment for our patients and may spare unnecessary operations.”