Endoscopic ultrasound with fine-needle aspiration in the diagnosis and staging of lung cancer.
BACKGROUND
Esophageal endoscopic ultrasonographic (EUS) guidance for fine-needle aspiration (FNA) of mediastinal lymph nodes has been introduced only recently. The utility of EUS/FNA in diagnosing and staging bronchogenic carcinoma is unknown.


METHODS
After a thoracic computed tomographic scan, 27 patients with known or suspected lung cancer underwent EUS. Accessible abnormal mediastinal lymph nodes were aspirated under EUS guidance. Patients with positive cytologic studies did not undergo further testing, whereas the remaining patients underwent mediastinal exploration. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated for both chest computed tomography and EUS/FNA:


RESULTS
Twenty-two of 27 patients had mediastinal adenopathy by computed tomography scan. Sixteen patients had positive findings on EUS, 15 with positive FNA (10 non-small cell lung cancer; 5 small cell lung cancer) and 1 with T4 status. Fourteen patients with positive FNA had lymph nodes sampled at level 5, level 7, or both. Of 11 patients with negative EUS/FNA, 2 had positive findings at operation (sensitivity 89%). The diagnosis of lung cancer was established in 7 patients.


CONCLUSIONS
The results showed that EUS/FNA improves the accuracy of computed tomographic scan in the staging of lung cancer. By accessing lymph nodes at levels 5 and 7, EUS/FNA complements mediastinoscopy and is considered the staging modality of choice in these regions. Positive EUS/FNA can obviate the need for further invasive staging.
Silvestri
G A
GA
Department of Surgery, Medical University of South Carolina, Charleston 29425, USA.
Hoffman
B J
BJ
Bhutani
M S
MS
Hawes
R H
RH
Coppage
L
L
Sanders-Cliette
A
A
Reed
C E
CE
D001707:Biopsy, Needle; D002283:Carcinoma, Bronchogenic / Q000000981:diagnostic imaging* / Q000473:pathology*; D004724:Endoscopy; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity; D014463:Ultrasonography