Endoscopic ultrasound guided fine-needle aspiration for ... Endoscopic ultrasound (EUS) uses an...

download Endoscopic ultrasound guided fine-needle aspiration for ... Endoscopic ultrasound (EUS) uses an echoendoscope

of 131

  • date post

    08-Aug-2020
  • Category

    Documents

  • view

    0
  • download

    0

Embed Size (px)

Transcript of Endoscopic ultrasound guided fine-needle aspiration for ... Endoscopic ultrasound (EUS) uses an...

  • Endoscopic ultrasound guided fine-needle

    aspiration for the staging of non-small cell lung

    cancer and the diagnosis of mediastinal masses

    May 2007

    MSAC application 1104

    Assessment report

  • © Commonwealth of Australia 2007

    ISBN (Print) 1-74186-505-0

    ISBN (Online) 1-74186-506-9

    ISSN (Print) 1443-7120

    ISSN (Online) 1443-7139

    First printed February 2008

    Paper-based publications

    © Commonwealth of Australia 2007 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney-General’s Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at http://www.ag.gov.au/cca Internet sites

    © Commonwealth of Australia 2007 This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, non-commercial use or use within your organisation. Apart from any use as permitted under the Copyright Act 1968, all other rights are reserved. Requests and inquiries concerning reproduction and rights should be addressed to Commonwealth Copyright Administration, Attorney-General’s Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at http://www.ag.gov.au/cca

    Electronic copies of the report can be obtained from the Medical Service Advisory Committee’s Internet site at http://www.msac.gov.au/

    Printed copies of the report can be obtained from:

    The Secretary Medical Services Advisory Committee Department of Health and Ageing Mail Drop 106 GPO Box 9848 Canberra ACT 2601

    Enquiries about the content of the report should be directed to the above address.

    The Medical Services Advisory Committee (MSAC) is an independent committee which has been established to provide advice to the Minister for Health and Ageing on the strength of evidence available on new and existing medical technologies and procedures in terms of their safety, effectiveness and cost- effectiveness. This advice will help to inform government decisions about which medical services should attract funding under Medicare.

    MSAC recommendations do not necessarily reflect the views of all individuals who participated in the MSAC evaluation. This report was prepared by the Medical Services Advisory Committee with the assistance of Dr John Gillespie, Mr Koji Makino, Mr Marc Bevan, Ms Keira Robinson, Ms Corinne LeReun and Dr Liesl Birinyi- Strachan from M-TAG Pty Ltd, a unit of IMS Health. The report was endorsed by the Minister for Health and Ageing on 29 August 2007.

    Publication approval number: P3-3021

  • EUS-FNA for the staging of NSCLC and the diagnosis of mediastinal masses iii

    Contents

    Executive summary................................................................................................. xi The procedure ................................................................................................................. xi Medical Services Advisory Committee–role and approach...................................... xi MSAC’s assessment of EUS-FNA for NSCLC staging and mediastinal mass diagnosis ................................................................................................................. xi

    Clinical need.............................................................................................................. xi Research questions.................................................................................................. xii Safety......................................................................................................................... xii Effectiveness............................................................................................................ xii Cost-effectiveness .................................................................................................. xiv

    Recommendation.......................................................................................................... xvi

    Introduction ..............................................................................................................1

    Background.............................................................................................................. 2 The procedure ........................................................................................................... 2 Intended purpose...................................................................................................... 5

    Non-small cell lung cancer ............................................................................................. 5 Clinical need............................................................................................................... 5 Incidence and mortality............................................................................................ 6 Eligible population.................................................................................................... 7 Current treatment ................................................................................................... 11

    Mediastinal masses......................................................................................................... 12 Clinical need............................................................................................................. 12 Eligible population.................................................................................................. 13 Current treatment ................................................................................................... 13

    Existing procedures....................................................................................................... 14 Mediastinoscopy...................................................................................................... 14 Mediastinotomy....................................................................................................... 14 Video-assisted thoracoscopy ................................................................................. 15 Transbronchial needle aspiration.......................................................................... 15 Transthoracic needle aspiration ............................................................................ 15

    Comparator..................................................................................................................... 15 Non-small cell lung cancer .................................................................................... 15 Mediastinal masses.................................................................................................. 16

    Marketing status of the device/technology ............................................................... 16 Current reimbursement arrangement ......................................................................... 17

    Approach to assessment .........................................................................................18 Research questions and clinical pathways .................................................................. 18

    Non-small cell lung cancer .................................................................................... 18 Mediastinal mass of unknown origin ................................................................... 20

    Assessment framework ................................................................................................. 22 Types of evidence ................................................................................................... 22

    Review of the literature................................................................................................. 22

  • iv EUS-FNA for the staging of NSCLC and the diagnosis of mediastinal masses

    Search strategy......................................................................................................... 22 Selection criteria ...................................................................................................... 23 Search results ........................................................................................................... 24

    Data extraction............................................................................................................... 26 Statistical methods ......................................................................................................... 26

    Methodological considerations ............................................................................. 26 Appraisal of the evidence ............................................................................................. 27

    Appraisal of the quality and applicability of individual studies ........................ 27 Expert advice.................................................................................................................. 29

    Results of assessment ............................................................................................ 30 Summary ......................................................................................................................... 30 Is it safe?.......................................................................................................................... 31 Is it effective? .................................