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Background The association between socioeconomic status (SES) and lung cancer is internationally established but in Australia this relationship remains ill defined. Aims To examine the association between SES, place of residence and lung cancer outcomes in a large Australian cohort. Methods 2369 consecutive lung cancer patients managed by St Vincent's Hospital lung multidisciplinary meeting between 2001–2014 were included. Postcode data stratified participants by Socio-Economic Indexes for Areas, a validated measure of SES, and by geographical location, an important socioeconomic factor in Australia. Results There was no difference between socioeconomic groups in age (68 years), sex (63% males) or presentation (75% symptomatic). Low socioeconomic patients had increased smoking rates and a trend towards less adenocarcinoma. More low SES patients were from rural locations, had a greater frequency of earlier stage disease and curative treatment with higher overall survival even after multivariate analysis. When stratified for socioeconomic status, overall 5-year survival was significantly better in the low SES group (33% vs 24%, n = 2275, p = 0.02), although stage-stratified survival was similar in all socioeconomic groups. Conclusions Low SES patients were more frequently from rural locations and unexpectedly had earlier stage disease and higher overall survival. The excellent outcomes in rural and lower SES patients is reassuring but suggests that there is a population of these patients with advanced lung cancer who are not referred for multidisciplinary care. Further studies are required to better define this group and determine the barriers to referral to improve overall lung cancer outcomes.

Background Lung cancer accounts for significant morbidity and mortality worldwide. The effect of recent changes in demographics and management on outcomes in Australia has not been clearly defined. Aims To compare three consecutive lung cancer cohorts to evaluate emergent differences in diagnosis, management and mortality. Methods For comparative analysis, 2119 lung cancer patients were divided into three successive cohorts. Current death data were sought from the Victorian Cancer Registry. Results Age at diagnosis, mode of presentation and pathology did not significantly differ between the groups. Significantly more females were diagnosed with lung cancer in the most recent cohort (P = 0.04). Amongst non-small-cell lung cancer patients, there were more adenocarcinomas and less large cell carcinomas in the latest cohort (P =

Background: The aim of this study was to assess the incremental value of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) to positron emission tomography (PET) in the diagnosis of unexplained mediastinal lymphadenopathy and staging of non-small-cell lung cancer (NSCLC). Methods: Patients who had both EUS-guided FNA and PET were retrospectively identified from an EUS database at a tertiary hospital. All EUS-guided FNA were carried out by one endoscopist between August 2002 and April 2005, either for the diagnosis of unexplained mediastinal lymphadenopathy or for the staging of NSCLC. Results of PET and EUS were compared with histology. A true histological positive result was defined as histological involvement in either surgery (mediastinoscopy or resection) or EUS-guided FNA. A true histological negative result was defined as negative involvement at surgery (mediastinoscopy or resection). Results: Forty-nine patients who had both PET scanning and EUS-guided FNA for diagnosis of unexplained mediastinal lymphadenopathy or staging of NSCLC were identified. Of these, 33 (73% males, n = 24, age range = 44–78 years, mean = 62 years) had surgical confirmation of mediastinal lymph node pathology. In these patients, PET alone showed sensitivity, 95%; specificity, 90%; positive predictive value, 87%; negative predictive value, 90% and accuracy, 88%; whereas the addition of EUS-guided FNA increased the overall specificity and positive predictive value to 100%, with an overall accuracy of 97%. Conclusions: This study suggests that EUS-guided FNA complements PET by improving the overall specificity and thereby the accuracy for diagnosis of unexplained mediastinal lymphadenopathy. It provides a minimally invasive technique to assess the mediastinum in patients with NSCLC and is particularly valuable in cases in which PET findings are equivocal.

Background: Thymectomy is an effective, but radical therapy for myasthenia. Video-assisted thoracic surgery (VATS) may allow a minimally invasive altern­ative to the standard sternotomy approach. Aims: To audit prospectively the outcome of VATS thymectomy for myasthenia gravis in a unit specializing in advanced VATS techniques. Methods: Twenty-six patients underwent VATS thymectomy between 1997 and 2001. Most underwent preoperative plasma exchange therapy. Seventeen women and nine men with a median age of 36 years (range 17−71 years) had a right-sided VATS approach to remove all anterior mediastinal fat and thymic tissue. Results: There was no perioperative mortality and all procedures were concluded successfully, with one patient requiring sternotomy. Twenty-five patients were extubated in theatre and one patient required 17 h of assisted ventilation. The other significant complication was a diathermy injury to the phrenic nerve, which recovered. Median postoperative stay was 4 days (range 2−6 days), with median postoper­ative chest drainage for 2 days (range 1−3 days). Three patients had progression of disease postoperatively. The remainder were asymptomatic (7), improved (14) or stable (2). Conclusion: In a dedicated unit with neurological and intensive care support, VATS thymectomy is a safe, effective method of obtaining remission or improvement in myasthenia gravis (MG). While achieving the same surgical goal, this approach offers advantages of improved cosmesis, shorter recovery time and minimal chest wall disruption over the gold standard of sternotomy. Better patient acceptance of this minimally invasive technique may result in wider application of the benefits of thymectomy in MG. (Intern Med J 2002; 32: 367−371)