[Transesophageal endoscopic ultrasonography in lung cancer involving mediastinal organs in the assessment of resectability].
The resectability of primary lung cancer depends on the extent of invasion to the mediastinum. To evaluate whether transesophageal endoscopic ultrasonography (E-EUS) could detect mediastinal invasion of lung cancer or not, this method was applied in 22 lung cancer cases in which mediastinal invasion was suspected on the basis of the chest roentgenogram and/or CT scan. An ultrasonic probe with a 5 MHz linear array transducer, 12 mm in diameter and 40 mm in length was attached to the tip of an esophagofiberscope for this study. Ultrasonographic findings were classified into four grades, grade 0; existence of a hyperechoic area between the tumor mass and the mediastinum, grade I; tumor mass in direct contact with mediastinum which appears to be normal in structure accompanied by movement of tumor mass on respiration, grade II; partial disappearance of laminar structures and changes in the mediastinal wall, with no movement of the tumor mass relative to the mediastinum, grade III; tumor invasion within the lumen of the mediastinum. Organs contained by the mediastinum include the pulmonary arteries, aorta, left atrium, pulmonary veins, superior vena cava (SVC) and the esophagus were clearly visualized in detail as real-time images, therefore more detailed information about changes in the laminar structures of walls could be obtained. The sensitivity, specificity and accuracy of E-EUS were 77.8%, 81.8% and 80.0%, respectively. E-EUS could detect mediastinal invasion more accurately than chest roentgenogram, CT or MRI. Particularly, in the SVC, descending aorta and esophagus, the longitudinal extent of tumor can be analyzed accurately. These results suggest that E-EUS can be useful to assess resectability and also to decide the surgical margin preoperatively in case of primary lung cancer in which mediastinal involvement is considered.
Sakio
H
H
Yamaguchi
Y
Y
D004945:Esophagoscopy; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008479:Mediastinal Neoplasms / Q000175:diagnosis* / Q000601:surgery; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D014463:Ultrasonography / Q000295:instrumentation / Q000379:methods*